Neighborhood characteristics, national health insurance program, and cognitive function among older adults: Findings from a national cohort study

Background. Declines in late life cognitive function differ greatly between neighborhoods but little is known if these effects are related to the availability of National Health Insurance (NHI).

Methods. Using a 14-year longitudinal national sample of older adults from Taiwan, this study employed mixed-effects models to assess community development index on cognitive decline in a nationally representative cohort, and to what extent is this relationship associated with the availability of NHI.

Results. Preliminary analyses did not find a significant decrease in cognitive function among older Taiwanese adults over the 14-year period since the establishment of NHI. Mixed-effects models indicated that degree of community development inhibits the onset of cognitive decline in older adulthood (â=0.04, p<0.001); moreover, the pre-NHI uninsured have a significantly lower onset of cognitive function than the pre-NHI insured government employees (â=-0.11, p<0.01), even after controlling for sex and childhood socioeconomic status. Yet, the difference in cognitive function was not significantly declined by various groups of NHI and degrees of community development over time.

Conclusions. These findings underscore the importance of assessing mechanisms through which neighborhood characteristics as predictors of late-life cognitive decline among older adults, and the differences between pre- and post-NHI in the influence of these predictors. Further analyses will explore the mechanisms on these relationships.