评估人际歧视和抑郁症状作为教育对认知影响的部分中介：来自非裔美国人健康老龄化研究（STAR）的证据。
Evaluating interpersonal discrimination and depressive symptoms as partial mediators of the effects of education on cognition: Evidence from the Study of Healthy Aging in African Americans (STAR).
机构信息
Center for Health and Community, University of California, San Francisco, California, USA.
Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA.
出版信息
Alzheimers Dement. 2023 Jul;19(7):3138-3147. doi: 10.1002/alz.12957. Epub 2023 Feb 1.
INTRODUCTION
Education is correlated with positive health outcomes, but associations are sometimes weaker among African Americans. The extent to which exposure to discrimination and depressive symptoms attenuates the education-cognition link has not been investigated.
METHODS
Study of Healthy Aging in African Americans (STAR) participants (n = 764; average age 69 years) completed the Spanish and English Neuropsychological Assessment Scales. We assessed everyday and major lifetime discrimination and depressive symptoms as mediators of education effects on cognition using G-estimation with measurement error corrections.
RESULTS
Education was correlated with greater major lifetime and everyday discrimination but lower depressive symptoms. Accounting for discrimination and depressive symptoms slightly reduced the estimated effect of education on cognition. The estimated total effect of graduate education (vs <Bachelor's) was 0.66 (95% confidence interval [CI]: 0.62, 0.68), and the direct effect not mediated by discrimination or depressive symptoms was 0.60 (95% CI: 0.43, 0.76).
DISCUSSION
Education has robust effects on later-life cognition after controlling multiple mediating pathways and offsetting mechanisms.
简介
教育与健康结果呈正相关，但这种关联在非裔美国人中有时较弱。尚未研究歧视和抑郁症状的暴露程度如何减弱教育与认知之间的联系。
方法
非裔美国人健康老龄化研究（STAR）参与者（n=764；平均年龄 69 岁）完成了西班牙语和英语神经心理评估量表。我们使用具有测量误差校正的 G 估计来评估日常和主要生活中的歧视和抑郁症状作为教育对认知影响的中介。
结果
教育与较大的主要生活和日常歧视呈正相关，但与较低的抑郁症状呈负相关。考虑到歧视和抑郁症状，教育对认知的估计影响略有降低。研究生教育（相对于学士学位）的估计总效应为 0.66（95%置信区间[CI]：0.62，0.68），不受歧视或抑郁症状中介的直接效应为 0.60（95% CI：0.43，0.76）。
讨论
在控制多种中介途径和抵消机制后，教育对晚年认知具有强大的影响。
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