Abstract
Mild cognitive impairment, a precursor of Alzheimer's disease, poses a significant public health challenge among older adults, particularly those who have experienced forced displacement. Studies indicate that socioeconomic increases can offer protective effects against cognitive impairment; however, the pattern of marginalization-related diminished returns (MDR) demonstrates that these benefits are not universal, with marginalized groups experiencing diminished health returns from socioeconomic advancements. This study examined the relationship between socioeconomic status (SES)-measured by poverty level and educational attainment-and self-reported cognitive difficulty (CD) in a nationally representative sample of older adult refugees, further nuanced by focusing on the moderating effect of Bhutanese ethnicity, chosen for their unique migration and resettlement experiences. Utilizing the 2021 Public Use Microdata Samples of the American Community Survey 5-year estimates and official refugee counts by the U.S. Department of Homeland Security, this study analyzed a sample of 5,666 resettled refugees. Binary logistic regression analysis showed that high school completion was associated with a 48% decrease in the odds of CD among refugees (AOR = 0.52, p < .001, 95% CI [0.39, 0.70]). Bhutanese ethnicity was also significantly associated with a more than threefold increase in odds of CD compared to other refugee groups (AOR = 3.52, p < .001, 95% CI [2.28, 5.44]). The interaction between Bhutanese ethnicity and poverty level suggested that higher income did not protect Bhutanese refugees from CD, providing evidence of the MDR pattern. Findings underscore the importance of nuanced analysis within marginalized groups to uncover specific social determinants of cognitive health.