Date of Award

Winter 12-8-2023

Degree Type


Degree Name

Master of Public Health (MPH)


Public Health

First Advisor

Jalayne J. Arias

Second Advisor

Christine E. Stauber


INTRODUCTION: Education is considered a protective factor against cognitive decline. However, the relationship between education and cognition may be further complicated by additional factors. Income may moderate the protective association of education against cognitive decline.

AIM: Here we evaluate the 2020 Health and Retirement Study (HRS) wave to examine the strength of the relationship between education, income, and cognitive impairment.

METHODS: A cross-sectional analysis of the education, income, and cognition scores of 15,412 respondents to the 2020 HRS survey.

RESULTS: Results from this analysis show lower income levels reduce the protective association between education and cognition. Education has a protective association against cognitive impairment. Adjusting the odds ratio for income increases the odds ratio from 0.46 ( 95% CI, 0.438, 0.477, P< .001) to 0.56 (95% CI, 0.537, 0.589, P< .001) and reduces the protective association between cognitive impairment and education. Controlling for income has a greater effect than controlling for race, nursing home residency, gender, and total comorbidities combined.

DISCUSSION: Education is the single modifiable risk factor most protective against cognitive impairment in this analysis, but income has a strong modifying effect on this relationship. Interventions and policy initiatives that focus on increasing education levels to protect against cognitive impairment in old age would be strengthened by integrating income in their analysis.


File Upload Confirmation