{"doi":"10.1001/jamaneurol.2022.5337","title":"State-Level Indicators of Childhood Educational Quality and Incident Dementia in Older Black and White Adults","abstract":"<jats:sec id=\"ab-noi220094-4\"><jats:title>Importance</jats:title><jats:p>Higher educational attainment is associated with reduced dementia risk, but the role of educational quality is understudied, presenting a major evidence gap, especially as it may contribute to racial inequities.</jats:p></jats:sec><jats:sec id=\"ab-noi220094-5\"><jats:title>Objective</jats:title><jats:p>To evaluate the association between state-level educational quality during childhood and dementia risk.</jats:p></jats:sec><jats:sec id=\"ab-noi220094-6\"><jats:title>Design, Setting, and Participants</jats:title><jats:p>This cohort study analyzed longitudinal data collected from January 1, 1997, through December 31, 2019 (23-year follow-up period). The sample comprised members of Kaiser Permanente Northern California (KPNC), a large integrated health care delivery system, who completed an optional survey during 1964-1972. Eligible individuals were US born; non-Hispanic Black or non-Hispanic White; aged 65 years or older as of January 1, 1996; were still alive; and did not have a dementia diagnosis or lapse in KPNC membership greater than 90 days between January 1 and December 31, 1996.</jats:p></jats:sec><jats:sec id=\"ab-noi220094-7\"><jats:title>Exposures</jats:title><jats:p>Historical state-level administrative indicators of school quality (school term length, student-teacher ratio, and attendance rates) linked to participants using birth state and birth year (with a 6-year lag) and divided into tertiles using the pooled sample.</jats:p></jats:sec><jats:sec id=\"ab-noi220094-8\"><jats:title>Main Outcomes and Measures</jats:title><jats:p>Dementia diagnoses from electronic health records between 1997 and 2019 were analyzed between March 1 and August 31, 2022. The associations of educational quality with incident dementia were estimated using Cox proportional hazards regression models.</jats:p></jats:sec><jats:sec id=\"ab-noi220094-9\"><jats:title>Results</jats:title><jats:p>Among 21 450 KPNC members who participated in the optional survey, individuals born before availability of educational quality records (n = 87) and missing educational attainment (n = 585) were excluded. The final analytic sample was 20 778 individuals (56.5% women, 43.5% men; mean [SD] age, 74.7 [6.5] years; 18.8% Black; 81.2% White; 41.0% with less than high school education). Among Black individuals, 76.2% to 86.1% (vs 20.8%-23.3% of White individuals) attended schools in states in the lowest educational quality tertiles. Highest (vs lowest) educational quality tertiles were associated with lower dementia risk (student-teacher ratio: hazard ratio [HR], 0.88 [95% CI, 0.83-0.94]; attendance rates: HR, 0.80 [95% CI, 0.73-0.88]; term length: HR, 0.79 [95% CI, 0.73-0.86]). Effect estimates did not differ by race and were not attenuated by adjustment for educational attainment.</jats:p></jats:sec><jats:sec id=\"ab-noi220094-10\"><jats:title>Conclusions and Relevance</jats:title><jats:p>In this cohort study, lower state-average educational quality was more common among Black individuals and associated with higher dementia risk. Differential investment in high-quality education due to structural racism may contribute to dementia disparities.</jats:p></jats:sec>","journal":"JAMA Neurology","year":2023,"id":637270,"datarank":0.611630616585858,"base_score":4.07753744390572,"endowment":4.07753744390572,"self_citation_contribution":0.611630616585858,"citation_network_contribution":0.0,"self_endowment_contribution":0.611630616585858,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":58,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":226637,"name":"Rachel A. Whitmer","orcid":"0009-0006-9511-6138","position":1,"is_corresponding":false},{"id":486559,"name":"Elizabeth Rose Mayeda","orcid":"0000-0002-6326-0163","position":2,"is_corresponding":false},{"id":106142,"name":"M. Maria Glymour","orcid":"0000-0001-9644-3081","position":3,"is_corresponding":false},{"id":715296,"name":"Rachel L. Peterson","orcid":"0000-0001-9834-9021","position":4,"is_corresponding":false},{"id":678825,"name":"Chloe W. Eng","orcid":"0000-0003-0034-9045","position":5,"is_corresponding":false},{"id":322968,"name":"Charles P. Quesenberry","orcid":"0000-0001-8272-9126","position":6,"is_corresponding":false},{"id":49960,"name":"Jennifer J. Manly","orcid":"0000-0002-9481-7497","position":7,"is_corresponding":false},{"id":366568,"name":"Paola Gilsanz","orcid":"0000-0002-7635-381X","position":8,"is_corresponding":false},{"id":1127960,"name":"Yenee Soh","orcid":"0000-0001-5200-7325","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"State-Level Indicators of Childhood Educational Quality and Incident Dementia in Older Black and White Adults","abstract":"<jats:sec id=\"ab-noi220094-4\"><jats:title>Importance</jats:title><jats:p>Higher educational attainment is associated with reduced dementia risk, but the role of educational quality is understudied, presenting a major evidence gap, especially as it may contribute to racial inequities.</jats:p></jats:sec><jats:sec id=\"ab-noi220094-5\"><jats:title>Objective</jats:title><jats:p>To evaluate the association between state-level educational quality during childhood and dementia risk.</jats:p></jats:sec><jats:sec id=\"ab-noi220094-6\"><jats:title>Design, Setting, and Participants</jats:title><jats:p>This cohort study analyzed longitudinal data collected from January 1, 1997, through December 31, 2019 (23-year follow-up period). The sample comprised members of Kaiser Permanente Northern California (KPNC), a large integrated health care delivery system, who completed an optional survey during 1964-1972. Eligible individuals were US born; non-Hispanic Black or non-Hispanic White; aged 65 years or older as of January 1, 1996; were still alive; and did not have a dementia diagnosis or lapse in KPNC membership greater than 90 days between January 1 and December 31, 1996.</jats:p></jats:sec><jats:sec id=\"ab-noi220094-7\"><jats:title>Exposures</jats:title><jats:p>Historical state-level administrative indicators of school quality (school term length, student-teacher ratio, and attendance rates) linked to participants using birth state and birth year (with a 6-year lag) and divided into tertiles using the pooled sample.</jats:p></jats:sec><jats:sec id=\"ab-noi220094-8\"><jats:title>Main Outcomes and Measures</jats:title><jats:p>Dementia diagnoses from electronic health records between 1997 and 2019 were analyzed between March 1 and August 31, 2022. The associations of educational quality with incident dementia were estimated using Cox proportional hazards regression models.</jats:p></jats:sec><jats:sec id=\"ab-noi220094-9\"><jats:title>Results</jats:title><jats:p>Among 21 450 KPNC members who participated in the optional survey, individuals born before availability of educational quality records (n = 87) and missing educational attainment (n = 585) were excluded. The final analytic sample was 20 778 individuals (56.5% women, 43.5% men; mean [SD] age, 74.7 [6.5] years; 18.8% Black; 81.2% White; 41.0% with less than high school education). Among Black individuals, 76.2% to 86.1% (vs 20.8%-23.3% of White individuals) attended schools in states in the lowest educational quality tertiles. Highest (vs lowest) educational quality tertiles were associated with lower dementia risk (student-teacher ratio: hazard ratio [HR], 0.88 [95% CI, 0.83-0.94]; attendance rates: HR, 0.80 [95% CI, 0.73-0.88]; term length: HR, 0.79 [95% CI, 0.73-0.86]). Effect estimates did not differ by race and were not attenuated by adjustment for educational attainment.</jats:p></jats:sec><jats:sec id=\"ab-noi220094-10\"><jats:title>Conclusions and Relevance</jats:title><jats:p>In this cohort study, lower state-average educational quality was more common among Black individuals and associated with higher dementia risk. Differential investment in high-quality education due to structural racism may contribute to dementia disparities.</jats:p></jats:sec>","is_dataset_classified":null,"base_score":4.07753744390572,"endowment":4.07753744390572,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"36780143","pmcid":"PMC9926357","openalex_id":"https://openalex.org/W4320486555","authors":[],"funders":[{"funder_name":"NIA NIH HHS","grant_id":"R01 AG052132","title":null},{"funder_name":"NIA NIH HHS","grant_id":"R01 AG039588","title":null},{"funder_name":"NIA NIH HHS","grant_id":"R01 AG066132","title":null}],"total_grants":3,"fwci":10.3942,"citation_percentile":0.99080732,"influential_citations":0,"citation_trend":[{"year":2023,"count":7},{"year":2024,"count":15},{"year":2025,"count":27},{"year":2026,"count":9}],"oa_status":"green","license":null,"oa_locations":[{"url":"https://www.ncbi.nlm.nih.gov/pmc/articles/9926357","host_type":"repository"},{"url":"https://www.ncbi.nlm.nih.gov/pmc/articles/9926357","host_type":"repository"},{"url":"https://jamanetwork.com/journals/jamaneurology/articlepdf/2801599/jamaneurology_soh_2023_oi_220094_1680038724.66641.pdf","host_type":"publisher"},{"url":"https://doi.org/10.1001/jamaneurol.2022.5337","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/36780143","host_type":"repository"}],"fields_of_study":["Dementia and Cognitive Impairment Research","Childhood Cancer Survivors' Quality of Life","Health disparities and outcomes","Male","Adult","Humans","Female","Aged","Cohort Studies","White","Educational Status","Socioeconomic Factors","Dementia"],"mesh_terms":["White","Adult","Aged","Dementia","Educational Status","Female","Humans","Male","Socioeconomic Factors","Cohort Studies"],"keywords":["Educational attainment","Medicine","Demography","Dementia","Attendance","Gerontology","Cohort"],"sdg_mappings":[{"sdg_number":0,"sdg_label":"Quality Education"}],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-08-06T18:40:04.606999Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}