Is state-level educational quality during childhood associated with dementia in older Black and White adults?

Education is a well-established risk factor for dementia, with numerous studies showing significant associations between lower educational levels and higher dementia risk. However, the literature on education and dementia predominantly focuses on educational quantity (ie, years of educational attainment), which may be insufficient to fully understand how education may influence dementia risk.

Substantial racial and ethnic inequities in dementia incidence exist in the US. Given the large educational disadvantage experienced among racial and ethnic minority groups, studies have examined whether differences in educational levels explain some of the racial and ethnic disparities in dementia risk. Although educational quantity explains a large portion of the differential risk across race and ethnicity, it does not fully explain the higher dementia burden among Black and Hispanic older adults.

In a large, longitudinal cohort of US-born older Black and White members with dementia, Soh et al found that higher state-level educational quality in the state of birth is associated with a lower risk of incident dementia. Among all participants, the medium and highest tertiles for student-teacher ratio, attendance rates, and school term length were associated with an 8% to 21% lower risk of dementia compared with the respective lowest tertiles. The authors further highlight that the associations of educational quality measures and dementia risk are not fully explained through educational attainment, suggesting that educational attainment may be inadequate when used alone to assess the association of education with dementia risk.

Educational quality is linked to higher educational attainment and income, which provide access to resources that protect or enhance health. Higher educational attainment may also be associated with a lower likelihood of working in hazardous occupations and a higher likelihood of working in mentally stimulating environments, which in turn are associated with a lower risk of dementia. Lower educational quality is also associated with less protective health behaviors (eg, more midlife obesity and smoking) that are common risk factors for dementia. Prior studies have also shown how educational quality is associated with vascular health–related factors (eg, hypertension), which in turn have been shown to be associated with dementia risk.

Reference: Yenee Soh; Rachel A. Whitmer; Elizabeth Rose Mayeda; et al JAMA Neurol. Published online February 13, 2023. doi:10.1001/jamaneurol.2022.5337