Differential Effects of Vascular Risk Factors and Health Behaviors on Cognitive Health in Urban and Rural Populations

Background This study aimed to compare vascular-risk profiles and health behaviors, and to examine their associations with cognitive function among older adults in urban and rural communities, where the burden of dementia differs. Methods We analyzed 1,284 non-demented older adults from two community cohorts (949 rural, 335 urban) with data on demographics, vascular risk factors, lifestyles, laboratory data, and comprehensive neuropsychological assessments. Suboptimal cognition was defined as > 1 SD below age-, sex-, and education-adjusted norms; predictors were examined using multivariable logistic regression separately for rural and urban groups, followed by interaction analyses to assess region-specific effects. Results Compared with urban cohort, rural participants were younger (70.1 ± 6.8 vs 71.3 ± 3.6 years), more often males (49.6% vs 30.4%), and less educated (4.0 ± 4.6 vs 14.2 ± 3.1 years). They also exhibited higher prevalence and poorer control of major vascular risk factors. In the rural population, low physical activity (OR, 95% CI = 1.74, 1.14–2.65), higher systolic BP (1.02, 1.01–1.04), and male (2.64, 1.51–4.62) were associated with poorer global cognitive function, while smoking cessation was protective (0.38, 0.19–0.77). Low physical activity (1.99, 1.37–2.88) further predicted poorer visuospatial function. No significant vascular-related predictors of cognition were observed in the urban population. Interaction analyses confirmed that the protective effect of smoking cessation on global cognition and the adverse effect of low physical activity on visuospatial function were more pronounced in rural participants. Conclusions Vascular lifestyle factors showed stronger associations with cognitive impairment in rural than urban older adults, underscoring the need for tailored, setting-specific prevention strategies.