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From the Departments of Psychiatry (Drs. Hall and Unverzagt, and Hendrie) and Medicine (Dr. Gao), Indiana University School of Medicine, Indianapolis, IN.
Address correspondence and reprint requests to Dr. Kathleen S. Hall, Indianapolis Study of Health and Aging, Department of Psychiatry, Indiana University School of Medicine, 541 Clinical Drive, Suite CL 395, Indianapolis, IN 46202-5111; e-mail: khall{at}iupui.edu
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 
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 (
6 years) or high (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 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.
Key words: AD—Risk factors—Childhood rural residence—Education—African Americans
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