Journal article
Rural versus Urban Residence in Adulthood and Incident Cognitive Impairment
Neuroepidemiology, v 57(4), pp 218-228
01 Oct 2023
PMID: 37231876
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Introduction: Rural versus urban living is a social determinant of cognitive health. We estimated the association of rural versus urban residence in the USA with incident cognitive impairment (ICI) and assessed effect heterogeneity by sociodemographic, behavioral, and clinical factors.
Methods: The Reasons for Geographic and Racial Differences in Stroke Study (REGARDS) is a population-based prospective observational cohort of 30,239 adults, 57% female, 36% Black, aged 45+ years, sampled from 48 contiguous states in the USA in 2003-2007. We analyzed 20,878 participants who at baseline were cognitively intact with no history of stroke and had ICI assessed on average 9.4 years later. We classified participants' home addresses at baseline as urban (population >= 50,000), large rural (10,000-49,999), or small rural (<= 9,999) by Rural-Urban Commuting Area codes. We defined ICI as >= 1.5 SD below the mean on at least 2 of the following tests: word list learning, word list delayed recall, and animal naming.
Results: Participants' home addresses were 79.8% urban, 11.7% large rural, and 8.5% small rural. ICI occurred in 1,658 participants (7.9%). Small rural residents had higher odds of ICI than urban residents, adjusted for age, sex, race, region, and education (OR = 1.34 [95% CI: 1.10, 1.64]), and after further adjustment for income, health behaviors, and clinical characteristics (OR = 1.24 [95% CI: 1.02, 1.53]). Former smoking versus never, nondrinking versus light alcohol drinking, no exercise versus >= 4 times/week, CES-D depressive symptom score of 2 versus 0, and fair versus excellent self-rated health had stronger associations with ICI in small rural areas than in urban areas. For example, in urban areas, lack of exercise was not associated with ICI (OR = 0.90 [95% CI: 0.77, 1.06]); however, lack of exercise combined with small rural residence was associated with 1.45 times the odds of ICI compared with >= 4 bouts of exercise/week in urban areas (95% CI: 1.03, 2.03). Overall, large rural residence was not associated with ICI; however, black race, hypertension, and depressive symptoms had somewhat weaker associations with ICI, and heavy alcohol drinking a stronger association with ICI, in large rural areas than in urban areas.
Conclusion: Small rural residence was associated with ICI among USA adults. Further research to better understand why rural residents are at higher risk for developing ICI and mechanisms to ameliorate that risk will support efforts to advance rural public health.
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Details
- Title
- Rural versus Urban Residence in Adulthood and Incident Cognitive Impairment
- Creators
- Matthew L. Harris - Brigham Young UniversityErica Bennion - Brigham Young Univ, Dept Publ Hlth, Provo, UT USAKristine R. Magnusson - Brigham Young UniversityVirginia J. Howard - University of Alabama at BirminghamVirginia G. Wadley - University of Alabama at BirminghamLeslie A. McClure - Drexel University, Epidemiology and BiostatisticsDeborah A. Levine - University of Michigan–Ann ArborJennifer J. Manly - Columbia UniversityJustina F. Avila - Columbia UniversityMaria Glymour - BiostatJonathan J. Wisco - Brigham Young Univ, Dept Physiol & Dev Biol, Provo, UT USAEvan L. Thacker - Brigham Young Univ, Dept Publ Hlth, Provo, UT USA
- Publication Details
- Neuroepidemiology, v 57(4), pp 218-228
- Publisher
- Karger
- Number of pages
- 11
- Grant note
- National Institute on Aging (NIA), National Institutes of Health, Department of Health and Human Services College Undergraduate Research Award from the College of Life Sciences, Brigham Young University U01 NS041588 / National Institute of Neurological Disorders and Stroke (NINDS); United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Neurological Disorders & Stroke (NINDS)
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Epidemiology and Biostatistics
- Web of Science ID
- WOS:001010236100001
- Scopus ID
- 2-s2.0-85174640793
- Other Identifier
- 991021861212204721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Clinical Neurology
- Public, Environmental & Occupational Health