Education Mediates Racial Disparities in Cognitive Impairment Among Older Adults With Schizophrenia

ABSTRACT

Objectives

In the general population, the construct of race is associated with disparities in cognitive aging. There are notable racial group disparities and inequities among people living with schizophrenia (PLWSz). Despite the salience of the construct of race in schizophrenia, there remains a knowledge gap about racial disparities in cognitive impairment among older adults in this vulnerable population. Our study uses mediation analysis to examine racial disparities in cognitive impairment among older adults with schizophrenia.

Methods

We assess global cognition in PLWSz over age 55 with the Measurement and Treatment Research to Improve Cognition in Schizophrenia cognitive test battery in our “all-comer” sample (N = 64). The primary exposure is self-reported racial group. We examine mediation of cognitive impairment through educational attainment, adjusting for psychiatric illness severity, history of substance use, and vascular risk factors.

Results

There was a Black/non-Black group racial disparity in global cognitive score (−2.8, 95% CI: −4.4, −1.3) after adjusting for confounding and interaction. This disparity was significantly mediated by years of education.

Conclusions

There are notable racial disparities in cognitive impairment among older adults with schizophrenia; however, differences in cognitive scores between racial groups are mediated by level of education.

Clinical Implications

Social determinants of health, particularly educational attainment, are important risk factors for cognitive impairment in PLWSz and should be considered by clinicians. Early screening and assessment of cognitive symptoms is essential to addressing health disparities/inequalities among older adults living with schizophrenia.

Abbreviations CDE

Controlled Direct EffectsHIV: Human Immunodeficiency VirusMATRICS: Measurement and Treatment Research to Improve Cognition in SchizophreniaMCCB: MATRICS Consensus Cognitive BatteryMTE: Marginal Total EffectsNDE: Natural Direct EffectsPANSS: Positive and Negative Symptom ScalePLWSz: People with schizophrenia

KEYWORDS:

• Aging
• cognitive impairment
• mediation
• racial disparities
• schizophrenia
• social determinants of health

Disclosure Statement

No potential conflict of interest was reported by the authors.

Supplementary Material

Supplemental data for this article can be accessed on the publisher’s website.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This manuscript was supported by a grant from the National Institute of Nursing Research of the National Institutes of Health (T32NR016920). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.