Interactive effects of chronic health conditions and financial hardship on episodic memory among older blacks: Findings from the Health and Retirement Study

Abstract

BackgroundPrevious research suggests that chronic health conditions and financial hardship robustly shape cognitive health outcomes, including ADRD risk in older Blacks. However, few studies have explored the moderating effect of financial hardship on chronic disease burden and specific cognitive domains. This study examined whether financial hardship modifies the impact of self‐reported chronic health conditions on episodic memory among a representative sample of older Blacks enrolled in the 2006 Health and Retirement Study (HRS).MethodThe study included 934 older Blacks (50+ years) who completed the psychosocial leave‐behind questionnaire in the 2006 wave of the HRS. Episodic memory included a composite standardized score of immediate and delayed recall. Six chronic health conditions (e.g., hypertension, diabetes, stroke) were summed and dichotomized (0‐1 vs. as ≥2 conditions). Financial hardship was assessed as self‐reported difficulty paying monthly bills (range: not at all=0 to very/completely=3). Weighted OLS regression models tested independent associations between chronic health conditions and episodic memory, controlling for sociodemographic characteristics. An interaction term tested moderation by financial hardship.ResultThe majority of the sample was female (39.34% male) and had less than a high school education (35.89%; Table 1). Financial hardship modified the association between chronic disease burden and episodic memory performance such that individuals who reported very little difficulty paying their monthly bills had significantly lower memory scores at high levels of disease burden compared to those reporting high financial difficulty after controlling for age, gender, education and income (F 2, 49 = 4.97, p= 0.011; see Table 2 and Figure 1).ConclusionThe present study adds to our understanding of cognitive aging among older Black Americans. Results support previous research, pointing to the independent negative effects of both chronic diseases and subjective financial burden, but also extend the literature by suggesting an interactive effect. Specifically, multimorbidity was more strongly associated with worse episodic memory functioning among older Blacks with less financial hardship, which appeared to be driven by the relatively low cognitive functioning among those with the greatest financial hardship. This pattern of results suggest that financial hardship may be just as consequential for cognitive aging as chronic diseases for older Blacks.