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Toxic Psychosocial Stress, Resiliency Resources and Time to Dementia Diagnosis in a Nationally Representative Sample of Older Americans in the Health and Retirement Study from 2006–2016

Background: Toxic stress (TS), resiliency-promoting factors (RPFs) and their interactions were investigated in relationship to incident dementia in a nationally representative sample (n = 6516) of American adults ≥50 years enrolled in the Health and Retirement Study between 2006 and 2016. Methods: T...

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Autores principales: Nkwata, Allan K., Zhang, Ming, Song, Xiao, Giordani, Bruno, Ezeamama, Amara E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8875619/
https://www.ncbi.nlm.nih.gov/pubmed/35206612
http://dx.doi.org/10.3390/ijerph19042419
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author Nkwata, Allan K.
Zhang, Ming
Song, Xiao
Giordani, Bruno
Ezeamama, Amara E.
author_facet Nkwata, Allan K.
Zhang, Ming
Song, Xiao
Giordani, Bruno
Ezeamama, Amara E.
author_sort Nkwata, Allan K.
collection PubMed
description Background: Toxic stress (TS), resiliency-promoting factors (RPFs) and their interactions were investigated in relationship to incident dementia in a nationally representative sample (n = 6516) of American adults ≥50 years enrolled in the Health and Retirement Study between 2006 and 2016. Methods: TS included experiences of everyday discrimination and RPF included personal mastery. Race/ethnicity was self-reported as African American, Caucasian, or Other. Multivariable Cox proportional hazards regression models estimated TS-, RPF- and race-associated hazard ratios (HR) for dementia diagnosis and 95% confidence intervals (CIs) with adjustment for comorbidity, lifestyle, and socio-demographic confounders. Results: Discrimination-associated risk of dementia diagnosis on average increased with education level [discrimination x education, p = 0.032; HR = 1.75 (95% CI: 1.01–3.03) if < high school, HR = 5.67 (95% CI: 2.94–10.94) if high school completed and HR = 2.48 (95% CI: 1.53–4.00) if ≥some college education]. Likewise, African American vs. Caucasian race disparity in new-onset dementia was evident (HR = 2.12, 95% CI: 1.42–3.17) among adults with high-mastery while absent (HR = 1.35, 95% CI: 0.75–2.41) among adults with low mastery (Mastery x Race, p = 0.01). Conclusions: TS is a contextual driver of incident dementia that seemingly operates in a race and RPF-dependent fashion among American adults. Association pattern suggests that TS may overwhelm the cognitive reserve benefit of RPF particularly in status-inconsistent contexts including persons subjected to discrimination despite high education and persons of African American descent despite high mastery. Policies that reduce discrimination and promote equitable treatment by race/ethnicity may support cognitive resiliency and reduce the risk of dementia diagnosis in adult Americans.
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spelling pubmed-88756192022-02-26 Toxic Psychosocial Stress, Resiliency Resources and Time to Dementia Diagnosis in a Nationally Representative Sample of Older Americans in the Health and Retirement Study from 2006–2016 Nkwata, Allan K. Zhang, Ming Song, Xiao Giordani, Bruno Ezeamama, Amara E. Int J Environ Res Public Health Article Background: Toxic stress (TS), resiliency-promoting factors (RPFs) and their interactions were investigated in relationship to incident dementia in a nationally representative sample (n = 6516) of American adults ≥50 years enrolled in the Health and Retirement Study between 2006 and 2016. Methods: TS included experiences of everyday discrimination and RPF included personal mastery. Race/ethnicity was self-reported as African American, Caucasian, or Other. Multivariable Cox proportional hazards regression models estimated TS-, RPF- and race-associated hazard ratios (HR) for dementia diagnosis and 95% confidence intervals (CIs) with adjustment for comorbidity, lifestyle, and socio-demographic confounders. Results: Discrimination-associated risk of dementia diagnosis on average increased with education level [discrimination x education, p = 0.032; HR = 1.75 (95% CI: 1.01–3.03) if < high school, HR = 5.67 (95% CI: 2.94–10.94) if high school completed and HR = 2.48 (95% CI: 1.53–4.00) if ≥some college education]. Likewise, African American vs. Caucasian race disparity in new-onset dementia was evident (HR = 2.12, 95% CI: 1.42–3.17) among adults with high-mastery while absent (HR = 1.35, 95% CI: 0.75–2.41) among adults with low mastery (Mastery x Race, p = 0.01). Conclusions: TS is a contextual driver of incident dementia that seemingly operates in a race and RPF-dependent fashion among American adults. Association pattern suggests that TS may overwhelm the cognitive reserve benefit of RPF particularly in status-inconsistent contexts including persons subjected to discrimination despite high education and persons of African American descent despite high mastery. Policies that reduce discrimination and promote equitable treatment by race/ethnicity may support cognitive resiliency and reduce the risk of dementia diagnosis in adult Americans. MDPI 2022-02-19 /pmc/articles/PMC8875619/ /pubmed/35206612 http://dx.doi.org/10.3390/ijerph19042419 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Nkwata, Allan K.
Zhang, Ming
Song, Xiao
Giordani, Bruno
Ezeamama, Amara E.
Toxic Psychosocial Stress, Resiliency Resources and Time to Dementia Diagnosis in a Nationally Representative Sample of Older Americans in the Health and Retirement Study from 2006–2016
title Toxic Psychosocial Stress, Resiliency Resources and Time to Dementia Diagnosis in a Nationally Representative Sample of Older Americans in the Health and Retirement Study from 2006–2016
title_full Toxic Psychosocial Stress, Resiliency Resources and Time to Dementia Diagnosis in a Nationally Representative Sample of Older Americans in the Health and Retirement Study from 2006–2016
title_fullStr Toxic Psychosocial Stress, Resiliency Resources and Time to Dementia Diagnosis in a Nationally Representative Sample of Older Americans in the Health and Retirement Study from 2006–2016
title_full_unstemmed Toxic Psychosocial Stress, Resiliency Resources and Time to Dementia Diagnosis in a Nationally Representative Sample of Older Americans in the Health and Retirement Study from 2006–2016
title_short Toxic Psychosocial Stress, Resiliency Resources and Time to Dementia Diagnosis in a Nationally Representative Sample of Older Americans in the Health and Retirement Study from 2006–2016
title_sort toxic psychosocial stress, resiliency resources and time to dementia diagnosis in a nationally representative sample of older americans in the health and retirement study from 2006–2016
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8875619/
https://www.ncbi.nlm.nih.gov/pubmed/35206612
http://dx.doi.org/10.3390/ijerph19042419
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