Low education and childhood rural residence - Risk for Alzheimer's disease in African Americans

Objective: To examine the relationship between level of education and childhood rural residence as possible risk factors for AD in African Americans in Indianapolis. Background: Low level of education has been a risk factor for AD in some studies, but childhood rural residence has not been addressed in most of these studies. Methods: A two-stage community-based prevalence study of AD was conducted in a random sample of 2,212 African Americans greater than or equal to 65 years of age. A subsample of clinically assessed normal individuals (180) and individuals diagnosed with AD (43) were compared on the variables of rural/urban residence in childhood and low (less than or equal to 6 years) or high (greater than or equal to 7 years) education. A logistic regression model was used with interaction between rural residence and low education to estimate odds ratios for the two risk factors combined, adjusting for age and gender. Results: Odds ratios for AD: 6.5 (95% CI: 2.6 to 16.7) low education/rural residence; 0.5 (95% CI: 0.1 to 2.9) low education/urban residence; 1.5 (95%; CI: 0.4 to 5.2) high education/rural residence, comparing with the group of high education/urban residence. Conclusion: Childhood rural residence, combined with less than or equal to 6 years of school, was associated with an increased risk of AD in this sample. It is possible that low education by itself is not a major risk factor for AD, but, rather, is a marker for other accompanying deleterious socioeconomic or environmental influences in childhood.