Mark D. Hayward

The risk of dementia is considerably lower among persons with a high educational attainment level than among less educated persons. This association has been documented across countries, cohorts, and populations. However, several questions remain unanswered. What is the rate of decline in dementia risk associated with additional education? Does the rate of decline with additional education differ across the education distribution? Are there key points in the education distribution that demark changes in the association, such as completing high school? Using the 2000–2018 Health and Retirement Study, we use a functional form approach to evaluate how dementia risk changes with each year of education among non-Hispanic White and Black older adults. We observe a linear decline in dementia incidence with increasing years of educational attainment, both before and after 12 years of education. This pattern is consistent across population subgroups. Additionally, dementia risk displays a step-change decline at 12 years of education, but this reduction is observed primarily among men and White adults. These findings underscore the significance of educational exposure in understanding population differences in dementia risk and future changes in the burden of dementia in the population.

Background and Objectives: Studies that examine the correlates of cognitive health among U.S. Hispanic older adults have not sufficiently explored the role of offspring resources. Given recent evidence of the importance of offspring education for older parents’ cognitive health, this study assesses whether the relationship between offspring education and Hispanic parents’ cognitive trajectories varies by nativity status. Research Design and Methods: Data come from the U.S. Health and Retirement Study (2000–2018). Multilevel models are used to evaluate the relationship between adult children’s college education and parents’ cognitive trajectories for Hispanic parents over age 50. We also determine whether the link between offspring schooling and parents’ cognitive trajectories differs in magnitude for foreign- versus native-born parents. Results: The results show that offspring college completion is associated with Hispanic parents’ initial cognitive scores, but not parents’ cognitive score trajectories. Moreover, the cognitive health of native-born parents is more sensitive to children’s college completion than that of foreign-born parents. These results are robust to controls for certain explanatory pathways, including offspring social support to parents, parents’ depressive symptoms, and parents’ health behaviors. Discussion and Implications: Children’s educational resources remain a hidden source of health disparities among older parents. Although our findings confirm this general relationship for older Hispanic adults’ cognitive health, significant diversity within the Hispanic community also suggests that children’s resources may play different roles for native- versus foreign-born parents. Future research is needed to clarify how nativity status and ethnicity jointly shape the relationship between family members’ resources and older adult cognitive health.

Objectives: A growing body of research examines how adult children’s education influences older parents’ cognitive health. Whereas prior studies tend to focus on educational advantage, this study seeks to understand how various measures of educational disadvantage are associated with parents’ dementia likelihood. In addition, we ask how the risks associated with one child’s educational disadvantage are shaped by a sibling’s educational success. Methods: Using data from the U.S. Health and Retirement Study (2000–2018) and event history analyses, comparisons are made between measures of offspring educational disadvantage and their relationships with parents’ risk of dementia onset. In addition, analyses are conducted to understand whether the link between one child’s educational disadvantage and parental dementia onset is influenced by a sibling’s educational advantage. Results: Educational disadvantage is associated with an increased risk of parental dementia onset, with a threshold measure for whether a parent had at least one child without a high school education providing the best model fit for the data. Moreover, the heightened risks associated with one child’s educational disadvantage are not offset by another sibling’s educational success. Discussion: Children’s educational deficits are a hidden source of health disparities among older parents. Although scholars in recent years have rightly focused on the importance of offspring education, more attention should be paid to conceptualizing how educational disadvantage matters for parents and how the educational attainment of each child shapes parents’ cognitive health.

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Policy Points: We reviewed some of the recent advances in education and health, arguing that attention to social contextual factors and the dynamics of social and institutional change provide critical insights into the ways in which the association is embedded in institutional contexts. Based on our findings, we believe incorporating this perspective is fundamentally important to ameliorate current negative trends and inequality in Americans’ health and longevity.

The rise in working-age mortality rates in the United States in recent decades largely reflects stalled declines in cardiovascular disease (CVD) mortality alongside rising mortality from alcohol-induced causes, suicide, and drug poisoning; and it has been especially severe in some U.S. states. Building on recent work, this study examined whether U.S. state policy contexts may be a central explanation. We modeled the associations between working-age mortality rates and state policies during 1999 to 2019. We used annual data from the 1999–2019 National Vital Statistics System to calculate state-level age-adjusted mortality rates for deaths from all causes and from CVD, alcohol-induced causes, suicide, and drug poisoning among adults ages 25–64 years. We merged that data with annual state-level data on eight policy domains, such as labor and taxes, where each domain was scored on a 0–1 conservative-to-liberal continuum. Results show that the policy domains were associated with working-age mortality. More conservative marijuana policies and more liberal policies on the environment, gun safety, labor, economic taxes, and tobacco taxes in a state were associated with lower mortality in that state. Especially strong associations were observed between certain domains and specific causes of death: between the gun safety domain and suicide mortality among men, between the labor domain and alcohol-induced mortality, and between both the economic tax and tobacco tax domains and CVD mortality. Simulations indicate that changing all policy domains in all states to a fully liberal orientation might have saved 171,030 lives in 2019, while changing them to a fully conservative orientation might have cost 217,635 lives.

Purpose: The COVID‐19 pandemic has illuminated various heterogeneities between urban and rural environments in public health. The SARS‐CoV‐2 virus initially spread into the United States from international ports of entry and into urban population centers, like New York City. Over the course of the pandemic, cases emerged in more rural areas, implicating issues of transportation and mobility. Additionally, many rural areas developed into national hotspots of prevalence and transmission. Our aim was to investigate the preliminary impacts of road travel on the spread of COVID‐19. This investigation has implications for future public health mitigation efforts and travel restrictions in the United States.Methods: County‐level COVID‐19 data were analyzed for spatiotemporal patterns in time‐to‐event distributions using animated choropleth maps. Data were obtained from The New York Times and the Bureau of the Census. The arrival event was estimated by examining the number of days between the first reported national case (January 21, 2020) and the date that each county attained a given prevalence rate. Of the 3108 coterminous US counties, 2887 were included in the analyses. Data reflect cases accumulated between January 21, 2020, and May 17, 2020.Findings: Animations revealed that COVID‐19 was transmitted along the path of interstates. Quantitative results indicated rural–urban differences in the estimated arrival time of COVID‐19. Counties that are intersected by interstates had an earlier arrival than non‐intersected counties. The arrival time difference was the greatest in the most rural counties and implicates road travel as a factor of transmission into rural communities.Conclusion: Human mobility via road travel introduced COVID‐19 into more rural communities. Interstate travel restrictions and road travel restrictions would have supported stronger mitigation efforts during the earlier stages of the COVID‐19 pandemic and reduced transmission via network contact.

Objectives: While a number of studies have documented a notable decline in age-standardized prevalence in dementia in the U.S. population, relatively little is known about how dementia has declined for specific age and race groups, and the importance of changing educational attainment on the downward trend. We assess (a) how the trends in dementia prevalence may have differed across age and race groups and (b) the role of changing educational attainment in understanding these trends. Methods: This article estimates a series of logistic regression models using data from the Health and Retirement Study (2000–2014) to assess the relative annual decline in dementia prevalence and the importance of improving educational attainment for non-Hispanic Whites and non-Hispanic Blacks. Results: Consistent with other studies, we found significant declines in dementia for non-Hispanic Blacks and non-Hispanic Whites across this period. Nonetheless, these declines were not uniform across age and race groups. Non-Hispanic Blacks aged 65–74 years had the steepest decline in this period. We also found that improved educational attainment in the population was fundamentally important in understanding declining dementia prevalence in the United States. Discussion: This study shows the importance of improvement in educational attainment in the early part of the twentieth century to understand the downward trend in dementia prevalence in the United States from 2000 to 2014.