Joseph Saenz

The Role of Education in the Relationship Between Age of Migration to the United States and Risk of Cognitive Impairment Among Older Mexican Americans

Prior research indicates age of migration is associated with cognitive health outcomes among older Mexican Americans; however, factors that explain this relationship are unclear. This study used eight waves from the Hispanic Established Populations for the Epidemiologic Study of the Elderly to examine the role of education in the risk for cognitive impairment (CI) by nativity, age of migration, and gender. Foreign-born women had a higher risk for CI than U.S.-born women, regardless of age of migration. After adjusting for education, this risk remained significant only for late-life migrant women (risk ratio [RR] = 1.28). Foreign-born men who migrated at >50 had significantly higher risk for CI compared to U.S.-born men (RR = 1.33) but not significant after adjusting for education. Findings from a decomposition analysis showed education significantly mediated the association between age of migration and CI. This study highlights the importance of education in explaining the association between age of migration and CI.

Age of Migration Differentials in Life Expectancy With Cognitive Impairment: 20-Year Findings From the Hispanic-EPESE

Background and Objectives To examine differences in life expectancy with cognitive impairment among older Mexican adults according to nativity (U.S.-born/foreign-born) and among immigrants, age of migration to the United States. Research Design and Methods This study employs 20 years of data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly to estimate the proportion of life spent cognitively healthy and cognitively impaired prior to death among older Mexican adults residing in the southwestern United States. We combine age-specific mortality rates with age-specific prevalence of cognitive impairment, defined as a Mini-Mental Status Exam score of less than 21 points to calculate Sullivan-based life table models with and without cognitive impairment in later life. Results Foreign-born Mexican immigrants have longer total life expectancy and comparable cognitive healthy life expectancy regardless of gender compared to U.S.-born Mexican-Americans. However, the foreign-born spend a greater number of years after age 65 with cognitive impairment relative to their U.S.-born counterparts. Furthermore, we document an advantage in life expectancy with cognitive impairment and proportion of years after age 65 cognitively healthy among mid-life immigrant men and women relative to early- and late-life migrants. Discussion and Implications The relationship between nativity, age of migration, and life expectancy with cognitive impairment means that the foreign-born are in more need of support and time-intensive care in late life. This issue merits special attention to develop appropriate and targeted screening efforts that reduce cognitive decline for diverse subgroups of older Mexican-origin adults as they age.

Indoor air pollution and cognitive function among older Mexican adults

Background A growing body of research suggests exposure to high levels of outdoor air pollution may negatively affect cognitive functioning in older adults, but less is known about the link between indoor sources of air pollution and cognitive functioning. We examine the association between exposure to indoor air pollution and cognitive function among older adults in Mexico, a developing country where combustion of biomass for domestic energy remains common. Method Data come from the 2012 Wave of the Mexican Health and Aging Study. The analytic sample consists of 13 023 Mexican adults over age 50. Indoor air pollution is assessed by the reported use of wood or coal as the household’s primary cooking fuel. Cognitive function is measured with assessments of verbal learning, verbal recall, attention, orientation and verbal fluency. Ordinary least squares regression is used to examine cross-sectional differences in cognitive function according to indoor air pollution exposure while accounting for demographic, household, health and economic characteristics. Results Approximately 16% of the sample reported using wood or coal as their primary cooking fuel, but this was far more common among those residing in the most rural areas (53%). Exposure to indoor air pollution was associated with poorer cognitive performance across all assessments, with the exception of verbal recall, even in fully adjusted models. Conclusions Indoor air pollution may be an important factor for the cognitive health of older Mexican adults. Public health efforts should continue to develop interventions to reduce exposure to indoor air pollution in rural Mexico.

Age of Migration and the Incidence of Cognitive Impairment: A Cohort Study of Elder Mexican-Americans

Abstract Background and Objectives To explore nativity and age of migration differentials in the incidence of cognitive impairment among older Mexican-Americans. Research Design and Methods We employ maximum-likelihood discrete time hazard models to estimate risk ratios of cognitive impairment in a sample of 2,708 Mexican-Americans 65 and older who were cognitively healthy at baseline over a follow-up period of up to 20 years. Results Late-life immigrant women have a 46% higher risk of cognitive impairment compared to U.S.-born Mexican-American women. Conversely, midlife immigrant men have a 29% lower risk of cognitive impairment compared to U.S.-born Mexican-American men. The incidence of cognitive impairment did not differ for early-life and midlife immigrant women relative to U.S.-born women or for early- and late-life immigrant men compared to U.S.-born men. Discussion and Implications Differences in cognitive impairment risk between U.S.-born and foreign-born Mexican-American subgroups may be partly due to health selectivity. Cognitive impairment is more prevalent among immigrant groups which may result in a higher burden on family members and/or high dependency on public resources. Programs are needed that can detect decline at earlier stages and reduce the risk for cognitive impairment among older immigrants entering their last decades of life.

Family size and old-age wellbeing: effects of the fertility transition in Mexico

ABSTRACT The present study aims to determine how family size affects psycho-social, economic and health wellbeing in old age differently across two cohorts with declining fertility. The data are from the 2012 Mexican Health and Ageing Study (MHAS) including respondents aged 50+ (N = 13,102). Poisson (standard and zero-inflated) and logistic regressions are used to model determinants of wellbeing in old age: psycho-social (depressive symptoms), economic (consumer durables and insurance) and health (chronic conditions). In the younger cohort, having fewer children is associated with fewer depressive symptoms and chronic conditions, and better economic wellbeing. For the older cohort, having fewer children is associated with lower economic wellbeing and higher odds of being uninsured. Lower fertility benefited the younger cohort (born after 1937), whereas the older cohort (born in 1937 or earlier) benefited from lower fertility only in chronic conditions. Further research is needed to continue exploring the old-age effects of the fertility transition.

Educational Gradients and Pathways of Disability Onset Among Older Mexicans.

Introduction: Educational disparities research is less common in developing countries. We evaluate whether educational gradients of disability onset exist in Mexico across groups (birth cohort and sex) and whether the association is unexplained or indirect via health (health behaviors, chronic conditions, and self-rated health) or economic (income, wealth, and health insurance) pathways. Method: Data come from the Mexican Health & Aging study. Activities of daily living are reported in 2001, 2003, and 2012 by respondents and spouses aged 50+ (N = 9,560). Groups are analyzed using logistic regression to test education–disability onset associations. Results: Significant education–ADL onset associations were observed across groups, and much of these associations were direct (unexplained by pathways). Indirect effects operated primarily through the health pathway. Discussion: Those with less education were disadvantaged in terms of disability across birth cohorts and sex. Unexplained effects of education may suggest unobserved mediators or differential returns to resources by educational level.

The role of education in the association between race/ethnicity/nativity, cognitive impairment, and dementia among older adults in the United States

BACKGROUND Older Black and Hispanic adults are more likely to be cognitively impaired than older White adults. Disadvantages in educational achievement for minority and immigrant populations may contribute to disparities in cognitive impairment. OBJECTIVE Examine the role of education in racial/ethnic and nativity differences in cognitive impairment/no dementia (CIND) and dementia among older US adults. METHODS Data comes from the 2012 Health and Retirement Study. A total of 19,099 participants aged ≥50 were included in the analysis. Participants were categorized as having normal cognition, CIND, or dementia based on the Telephone Interview for Cognitive Status (TICS) or questions from a proxy interview. We document age and educational differences in cognitive status among White, Black, US-born Hispanic, and foreign-born Hispanic adults by sex. Logistic regression is used to quantify the association between race/ethnicity/nativity, education, and cognitive status by sex. RESULTS Among women, foreign-born Hispanics have higher odds of CIND and dementia than Whites. For men, Blacks have higher odds for CIND and dementia compared to Whites. The higher odds for CIND and dementia across race/ethnic and nativity groups was reduced after controlling for years of education but remained statistically significant for older Black and US-born Hispanic adults. Controlling for education reduces the odds for CIND (women and men) and dementia (men) among foreign-born Hispanics to nonsignificance. CONTRIBUTION These results highlight the importance of education in CIND and dementia, particularly among foreign-born Hispanics. Addressing inequalities in education can contribute to reducing racial/ethnic/nativity disparities in CIND and dementia for older adults.

Health Insurance and the Aging: Evidence From the Seguro Popular Program in Mexico

Aimed at covering the large fraction of workers in the informal sector without access to a social security program, the Mexican public health insurance program Seguro Popular began in 2002 and now reaches more than 50 million individuals. We estimate impacts of Seguro Popular for the population aged 50 and older on a set of indicators related to health care including utilization, diagnostic/preventive tests, and treatment conditional on being ill. Using the longitudinal Mexican Health and Aging Study over the period 2001–2012, we conduct before and after difference-in-difference matching impact estimators. Our results suggest large and important effects of the Program on utilization and diagnostic tests. We find overall smaller effects on the probability of being in treatment for individuals with chronic diseases, but these effects are concentrated in rural areas with relatively more health services versus rural areas with lower levels of health services. These results suggest that, to the extent that health services become more available in rural areas lacking services, effects of health insurance may increase.