title: Household and neighborhood conditions partially account for associations between education and physical capacity in the National Health and Aging Trends Study.
abstract: Socioeconomic resources, such as education, prevent disability but are not readily modifiable. We tested the hypothesis that household and neighborhood conditions, which may be modifiable, partially account for associations between education and physical capacity in a population-based sample of older adults. The National Health and Aging Trends Study measured education (<high school, high school, some college, and ≥Bachelor's), household and neighborhood conditions, using a 16-item environmental checklist and a 3-item social cohesion scale, and physical capacity with the Short Physical Performance Battery (SPPB), grip strength and peak expiratory flow. Structural equation models were used to decompose total educational effects into direct effects and indirect effects via household and neighborhood conditions, using sample weights and adjusting for age, sex, race/ethnicity, marital status, household size, BMI, self-reported health, and number of medical conditions in 6874 community-dwelling participants. Education was directly associated with SPPB scores (β = 0.055, p < 0.05) and peak flow (β = 0.095, p < 0.05), but not grip strength. Also, indirect effects were found for household disorder with SPPB scores (β = 0.013, p < 0.05), grip strength (β = 0.007, p < 0.05), and peak flow (β = 0.010, p < 0.05). Indirect effects were also found for street disorder with SPPB scores (β = 0.012, p < 0.05). Indirect effects of household and neighborhood conditions accounted for approximately 35%, 27% and 14% of the total association between education and SPPB scores, grip strength level, and peak expiratory flow level, respectively. Household disorder and street disorder partially accounted for educational disparities in physical capacity. However, educational disparities in SPPB scores and peak expiratory flow persisted after accounting for household and neighborhood conditions and chronic conditions, suggesting additional pathways. Interventions and policies aiming to support aging in place should consider addressing household-level and street-level disorder.
authors.affiliation: Johns Hopkins University, Department of Epidemiology, Center on Aging and Health, 2024 East Monument St., Suite 2-700, Baltimore, MD 21205, USA. Electronic address: lsamuel@jhmi.edu.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Samuel
authors.affiliation: Johns Hopkins University Bloomberg School of Public Health, Department of Epidemiology, 615 N. Wolfe St., E6144, Baltimore, MD 21205, USA. Electronic address: tglass1@jhu.edu.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Glass
authors.affiliation: Johns Hopkins University, Hopkins Center for Health Disparities Solutions, Bloomberg School of Public Health, Department of Health, Behavior and Society, 624 North Broadway, Baltimore, MD 21205, USA. Electronic address: rthorpe@jhsph.edu.
authors.forename: Roland J
authors.initials: RJ
authors.lastname: Thorpe
authors.affiliation: Johns Hopkins University, School of Nursing and Bloomberg School of Public Health, Department of Health Policy and Management, 525 North Wolfe Street #424, Baltimore, MD 21205, USA. Electronic address: sszanto1@jhu.edu.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Szanton
authors.affiliation: Johns Hopkins Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Department of Medicine, Center on Aging and Health, 2024 East Monument St., Suite 2-700, Baltimore, MD 21205, USA. Electronic address: droth@jhu.edu.
authors.forename: David L
authors.initials: DL
authors.lastname: Roth
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D004522:Educational Status; D005260:Female; D015577:Geriatric Assessment; D006306:Health Surveys; D006798:Housing; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D006278:Medicare; D012111:Residence Characteristics; D012494:Sampling Studies; D012931:Social Environment; D014481:United States
keywords: Disability; Education; Environment; Household conditions; Neighborhood; Older adults; Physical function; Socioeconomic status