Diabetes and cognitive decline : investigating the potential influence of factors related to health disparities

• OBJECTIVE: The authors investigated whether factors related to health disparities--race, rural residence, education, perceived racial discrimination, vascular disease, and health care access and utilization--may moderate the association between diabetes and cognitive decline.METHOD: Participants were 624 community-dwelling older adults (49% African American and 49% rural) who completed in-home mini-mental state examination at baseline and 4-year follow-up.RESULTS: Diabetes at baseline predicted four-year cognitive decline in regression models adjusted for a number of possible confounds. Only perceived discrimination and health utilization showed significant interaction effects with diabetes. Among African Americans who reported experiencing racial discrimination, there was a stronger relationship between diabetes and cognitive decline. Among participants who reported absence of visiting a physician within the past 6 months, the association between diabetes and cognitive decline was substantially larger.DISCUSSION: Findings suggest that factors related to health disparities may influence cognitive outcomes among older adults with diabetes.

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