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Abstract
Background and Objectives Studies on the effect of the Supplemental Nutrition Assistance Program (SNAP) on the cognitive health of older adults are scarce. We sought to examine the associations between SNAP use and memory decline among SNAP-eligible US older adults.
Methods Participants aged 50+ years and SNAP-eligible in 1996 from the Health and Retirement Study were included. Participants' SNAP eligibility was constructed using federal criteria. Participants also self-reported whether they used SNAP. Memory function was assessed biennially from 1996 through 2016 using a composite score. To account for preexisting differences in characteristics between SNAP users and nonusers, we modeled the probability of SNAP use using demographic and health covariates. Using linear mixed-effects models, we then modeled trajectories of memory function for SNAP users and nonusers using inverse probability (IP) weighting and propensity score (PS) matching techniques. In all models, we accounted for study attrition.
Results Of the 3,555 SNAP-eligible participants, a total of 15.7% were SNAP users. At baseline, SNAP users had lower socioeconomic status and a greater number of chronic conditions than nonusers and were more likely to be lost to follow-up. Our multivariable IP-weighted models suggested that SNAP users had worse memory scores at baseline but slower rates of memory decline compared with nonusers (the annual decline rate is −0.038 standardized units [95% CI = −0.044 to −0.032] for users and −0.046 [95% CI = −0.049 to −0.043] for nonusers). Results were slightly stronger from the PS-matched sample (N = 1,014) (the annual decline rate was −0.046 units [95% CI = −0.050 to −0.042] for users and −0.060 units [95% CI = −0.064 to −0.056] for nonusers). Put in other words, our findings suggested that SNAP users had approximately 2 fewer years of cognitive aging over a 10-year period compared with nonusers.
Discussion After accounting for preexisting differences between eligible SNAP users and nonusers as well as differential attrition, we find SNAP use to be associated with slower memory function decline.
Glossary
- FPL=
- federal poverty level;
- HS=
- high school;
- HRS=
- Health and Retirement Study;
- IP=
- inverse probability;
- IPAW=
- IP attrition weight;
- IPTW=
- IP of treatment weight;
- PS=
- propensity score;
- SNAP=
- Supplemental Nutrition Assistance Program
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Submitted and externally peer reviewed. The handling editors were Andrea Schneider, MD, PhD, and Brad Worrall, MD, MSc, FAAN.
Editorial, page 269
CME Course: NPub.org/cmelist
- Received April 26, 2022.
- Accepted in final form September 16, 2022.
- © 2022 American Academy of Neurology
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