WEALTH INEQUALITIES IN PHYSICAL AND COGNITIVE IMPAIRMENTS AMONG OLDER ADULTS ACROSS EUROPE AND JAPAN

Abstract Although prior research has provided insights on the association between country-level factors and health inequalities, key research gaps remain. First, most previous studies examine subjective rather than objective health measures. Second, the wealth dimension in health inequalities is understudied. Third, a handful of studies explicitly focus on older adults. To bridge these research gaps, this study aims to: i) measure wealth-related health inequalities in physical and cognitive impairments; and ii) examines the extent to which welfare states moderate wealth inequalities in physical and cognitive impairments among older people across Japan and Europe. We utilized harmonized data of non-institutionalized individuals aged 50-75 for physical and cognitive impairments from the Japanese Study of Aging and Retirement (JSTAR) and the Survey of Health, Ageing and Retirement in Europe (SHARE), for (n= 31,969 and 31,348, respectively). We applied a concentration index to quantify the degree of wealth inequalities in impairments. Our multilevel linear regression analyses examined whether national public health spending and healthcare access resources explained cross-country differences in wealth inequalities in physical and cognitive impairments. Findings indicated that inequalities in both impairment outcomes favored wealthier individuals in all countries, but the magnitude of inequality varied across countries under examination. Furthermore, a higher share of public health spending, lower out-of-pocket expenditures, and higher investment in healthcare resources were associated with lower wealth inequalities especially for physical impairments. Our findings suggests that different health interventions and policies may be needed to mitigate specific impairment inequalities.


COHORT DIFFERENCES IN EARLY-LIFE SOCIOECONOMIC STATUS AND LATE-LIFE COGNITIVE IMPAIRMENT IN MEXICO
Brian Downer 1 , Mariela Gutierrez 1 , Silvia Mejia Arango 2 , and Rebeca Wong 1 , 1. University of Texas Medical Branch,Galveston,Texas,United States,2. Colegio de la Frontera Norte,Tijuana,Baja California,Mexico Socioeconomic characteristics over the life course are associated with late-life cognitive impairment. However, evidence is lacking from countries like Mexico where population aging is occurring in the context of rapidly changing socioeconomic conditions. We used the Mexican Health and Aging Study to investigate differences between participants aged 60-76 in 2001 (n=5085) and 2018 (n=5947) in childhood (home with indoor toilet, parents' education) and midlife (education, longest held occupation) socioeconomic characteristics and late life cognitive impairment. Cognitive impairment was defined as a low score on >2 out of five assessments. Most participants in the 2018 cohort lived in a home with an indoor toilet as a child (58.1%) and 36.9% had parents who both completed at least some education compared to 41.9% and 28.7% of participants in the 2001 cohort, respectively. Men and women in 2018 had on average 2.34 and 1.83 more years of education than men and women in 2001, respectively. The percentage of women with no main job and men who worked in agriculture were lower in 2018 than 2001 (women: 27.0% vs. 34.6%; men: 23.3% vs. 30.4%). The 2018 cohort had lower odds for cognitive impairment when adjusting for age, sex, marital status, and living in a rural/urban community (OR=0.67 95% CI=0.56-0.81). This difference was reduced after adjusting for childhood socioeconomic measures (OR=0.76 95% CI=0.67-0.86) and was no longer statistically significant after adding midlife socioeconomic measures (OR=0.98 95% CI=0.86-1.12). These findings suggest that improved early-life socioeconomic conditions in Mexico contribute to birth-cohort differences in late-life cognitive impairment.

PSYCHIATRIC HISTORY AND LATER-LIFE COGNITIVE CHANGE: EFFECT MODIFICATION BY SEX, RACE, AND ETHNICITY Maria Brown, and Miriam Mutambudzi, Syracuse University, Syracuse, New York, United States
Objective: To better understand life course influences affecting cognitive function and decline in later life, we explored sex and race/ethnicity differentials in the relationship between a history of psychiatric, emotional, or nervous problems and cognitive functioning in later life, while accounting for early life disadvantage and relevant covariates.
Methods: Multi-level growth curve models examined associations between psychiatric history and cognitive functioning, and differences by sex and race/ethnicity (SRE), in 20,155 Health and Retirement Study (1995-2014) participants aged 65 or older, by estimating cognition scores and plotting trajectories of change with age by SRE.
Results: A history of psychiatric, emotional, or nervous problems was significantly related to cognition scores and rates of decline. Hispanic and Black participants had significantly lower cognition scores at age 75 and steeper rates of decline than White females, and Black race and the Hispanic race-sex interaction erased the protective effects of being female.
Conclusions: Our findings indicate that members of minority groups with a history of psychiatric problems evidence lower cognitive function in later life, and as a result, have a greater need for community-based long-term care than their peers without this history. Future research should include longitudinal analyses of different components of cognitive function, specific psychiatric diagnoses, and life history data that capture socioeconomic and psychosocial experiences throughout the life course. Population level findings as reported here, along with aggregate findings from similar studies, can inform interventions and policies regarding support for populations that are vulnerable to mental illness and to subsequent cognitive decline.