Primary Submission Category: Aging
Childhood Health and Later-Life Cognitive Functioning: The Mediating Role of Education
Authors: Nicole Hair
Presenting Author: Nicole Hair*
Educational attainment is one of the strongest predictors of dementia among older adults. It is unclear, however, whether this connection reflects the benefits of education per se or, rather, early life factors that influence educational attainment. We use the introduction of a measles vaccine in 1963, and the subsequent dramatic reductions in childhood infectious disease morbidity, to evaluate the effect of better overall health in childhood on cognition later in life and to assess the role of educational attainment in the causal pathway. Our project links historical data on state-level measles incidence rates to the Health and Retirement Study, a longitudinal population-based study of individuals over age 50 with validated cognitive measures. Our difference-in-differences approach compares outcomes across year-of-birth cohorts with more or less childhood exposure to the measles vaccine and across states with higher or lower pre-vaccine measles incidence. Compared to individuals born earlier and in states with low pre-vaccine incidence, those born later and in states with high pre-vaccine incidence are expected to have benefited more from measles vaccination. Reduced exposure to infectious disease (and improved overall childhood health) may impact cognition directly or indirectly, e.g., through its effects on educational attainment. We apply a causal mediation analysis framework, to determine to what extent higher levels of educational attainment explain the relationship between better overall childhood health and higher levels of later life cognitive functioning. Finally, because the benefits of mass vaccination campaigns were not shared equally and, in fact, racial and socioeconomic disparities in measles immunization persisted for decades, we estimate models stratified by race and childhood socioeconomic status to account for potentially important differences in the relationships between childhood health, educational attainment, and later life cognition.