{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T12:17:50Z","timestamp":1777033070542,"version":"3.51.4"},"reference-count":53,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2024,9,13]],"date-time":"2024-09-13T00:00:00Z","timestamp":1726185600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000001","name":"National Science Foundation","doi-asserted-by":"publisher","award":["2100729"],"award-info":[{"award-number":["2100729"]}],"id":[{"id":"10.13039\/100000001","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Subjective cognitive decline (SCD) is one of the most important early onset symptoms of Alzheimer\u2019s Disease. Previous studies consistently reported that SCD is associated with quality of life, socio-economic factors, and related health comorbidities. However, the impact of veteran status on SCD has been little investigated. This study conducted a cross-sectional study to address disproportionate effects in subjective cognitive decline between veterans and non-veterans in the United States. Propensity score matching (PSM) was applied in this observational study to achieve covariate balancing and reduce selection bias, providing a more accurate estimate of the isolated effect of veteran status on SCD. Our study utilized 32,431 forty-five years or older non-institutionalized White, Black or African-American, and Hispanic or Latin-American male population from the 2019 Behavioral Risk Factor Surveillance System data. We first identified 10,685 paired PSM samples for the binary veteran status using the preselected covariates. Next, we performed a logistic regression for modeling the relationship between the veteran status and the SCD status using the PSM samples along with the covariates selected by a BIC-based stepwise selection. Our analyses revealed a statistically significant causal association between veteran status and SCD after PSM (odds ratio (OR): 1.16 and 95% confidence interval (CI): 1.06\u20131.27). We obtained a similar result before PSM with an OR of 1.20 and 95% CI of 1.10\u20131.31. When we focused on a minority group (Black or African-American males), we found a significantly increased veterans\u2019 risk of SCD, especially after propensity score matching (OR: 1.69, 95% CI: 1.16\u20132.45). We also found several factors such as employment status, difficulty dressing\/walking\/running errands, general health status, physical health status, unaffordability of medical costs, mental health status, and comorbid conditions including stroke, blindness, high cholesterol, and arthritis as statistically significantly associated with SCD (<jats:italic>P-value<\/jats:italic> &lt; 0.05). Similar to post-traumatic stress disorder and traumatic brain injury, our study demonstrated a causal association between SCD and military-related activities in the United States, which has a disproportionate impact on the minority population. This study sets the groundwork to further research in this domain to diagnose neurological diseases early among veterans.<\/jats:p>","DOI":"10.1371\/journal.pone.0310102","type":"journal-article","created":{"date-parts":[[2024,9,13]],"date-time":"2024-09-13T17:35:32Z","timestamp":1726248932000},"page":"e0310102","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Evaluating disparity of subjective cognitive decline between male veterans and non-veterans in the United States using propensity score matching estimation: A behavioral risk factor surveillance system survey cross-sectional study"],"prefix":"10.1371","volume":"19","author":[{"given":"Chinenye","family":"Ifebirinachi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1472-0071","authenticated-orcid":true,"given":"Man Sik","family":"Park","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7436-1405","authenticated-orcid":true,"given":"Seong-Tae","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,9,13]]},"reference":[{"issue":"12","key":"pone.0310102.ref001","doi-asserted-by":"crossref","first-page":"1939","DOI":"10.1017\/S1041610217001399","article-title":"Subjective cognitive decline is longitudinally associated with lower health-related quality of life.","volume":"29","author":"S Roehr","year":"2017","journal-title":"Int Psychogeriatr."},{"issue":"5","key":"pone.0310102.ref002","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1186\/alzrt143","article-title":"Dementia: a global health priority\u2014highlights from an ADI and World Health Organization report.","volume":"4","author":"M. 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Kim","year":"2004","journal-title":"Am J Prev Med."},{"key":"pone.0310102.ref016","first-page":"666","volume-title":"In: 19 An Economic Analysis of Adult Obesity: Results from the Behavioral Risk Factor Surveillance System [Internet]","author":"SY Chou","year":"2017"},{"issue":"12","key":"pone.0310102.ref017","doi-asserted-by":"crossref","first-page":"1383","DOI":"10.1176\/ps.2008.59.12.1383","article-title":"Depression and anxiety in the United States: findings from the 2006 Behavioral Risk Factor Surveillance System.","volume":"59","author":"TW Strine","year":"2008","journal-title":"Psychiatr Serv."},{"issue":"2","key":"pone.0310102.ref018","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1016\/j.amepre.2019.03.015","article-title":"Lung cancer screening utilization: a Behavioral Risk Factor Surveillance System analysis.","volume":"57","author":"WE Zahnd","year":"2019","journal-title":"Am J Prev 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review.","volume":"86","author":"GW Imbens","year":"2004","journal-title":"Rev Econ Stat."},{"issue":"1","key":"pone.0310102.ref025","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1093\/biomet\/70.1.41","article-title":"The central role of the propensity score in observational studies for causal effects","volume":"70","author":"PR Rosenbaum","year":"1983","journal-title":"Biometrika"},{"issue":"467","key":"pone.0310102.ref026","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1198\/016214504000001187","article-title":"Causal inference with general treatment regimes: generalizing the propensity score","volume":"99","author":"K Imai","year":"2004","journal-title":"Journal of the American Statistical Association"},{"issue":"6","key":"pone.0310102.ref027","doi-asserted-by":"crossref","first-page":"848","DOI":"10.15288\/jsad.2008.69.848","article-title":"Teenage alcohol use and educational attainment","volume":"69","author":"J Staff","year":"2008","journal-title":"J Stud 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Wang","year":"2021","journal-title":"Pharmaceutical Statistics."},{"issue":"10","key":"pone.0310102.ref043","doi-asserted-by":"crossref","first-page":"1563","DOI":"10.1002\/sim.2053","article-title":"The use of the propensity score for estimating treatment effects: administrative versus clinical data.","volume":"24","author":"PC Austin","year":"2005","journal-title":"Stat Med."},{"issue":"8","key":"pone.0310102.ref044","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1177\/0018720819839817","article-title":"The impact of environmental stress on cognitive performance: a systematic review.","volume":"61","author":"K Martin","year":"2019","journal-title":"Hum Factors."},{"issue":"5","key":"pone.0310102.ref045","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1002\/1097-4679(198909)45:5<729::AID-JCLP2270450507>3.0.CO;2-H","article-title":"Ethnicity: Post-Traumatic Stress Disorder (PTSD) differences among black, white, and Hispanic veterans who differ in degrees of exposure to combat in Vietnam.","volume":"45","author":"WE Penk","year":"1989","journal-title":"Journal of Clinical Psychology"},{"issue":"3","key":"pone.0310102.ref046","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1016\/j.janxdis.2010.11.002","article-title":"Prolonged exposure therapy for combat-related posttraumatic stress disorder: an examination of treatment effectiveness for veterans of the wars in Afghanistan and Iraq","volume":"25","author":"PW Tuerk","year":"2011","journal-title":"Journal of Anxiety Disorders"},{"issue":"8","key":"pone.0310102.ref047","doi-asserted-by":"crossref","first-page":"1696","DOI":"10.2105\/AJPH.2014.302545","article-title":"Racial\/ethnic differences in combat- and non\u2013combat-associated traumatic brain injury severity in the veterans health administration: 2004\u20132010.","volume":"105","author":"CE Dismuke","year":"2015","journal-title":"Am J Public Health."},{"issue":"10","key":"pone.0310102.ref048","doi-asserted-by":"crossref","first-page":"249","DOI":"10.15585\/mmwr.mm7210a1","article-title":"Racial and ethnic differences in Subjective Cognitive Decline\u2014United States, 2015\u20132020","volume":"72","author":"KG Wooten","year":"2023","journal-title":"Morbidity and Mortality Weekly Report"},{"issue":"7","key":"pone.0310102.ref049","doi-asserted-by":"crossref","first-page":"2269","DOI":"10.1111\/jocs.15534","article-title":"The impact of patient-prosthesis mismatch on early and long-term survival after aortic replacement with the Edwards Perimount valve: a propensity score-matched analysis.","volume":"36","author":"R Marsico","year":"2021","journal-title":"J Card Surg"},{"issue":"1","key":"pone.0310102.ref050","article-title":"Variable selection in causal inference using a simultaneous penalization method.","volume":"6","author":"A Ertefaie","year":"2018","journal-title":"J Causal Inference [Internet]."},{"issue":"3","key":"pone.0310102.ref051","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1111\/j.1541-0420.2011.01731.x","article-title":"Bayesian effect estimation accounting for adjustment uncertainty","volume":"68","author":"C Wang","year":"2012","journal-title":"Biometrics"},{"issue":"2","key":"pone.0310102.ref052","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1111\/biom.12622","article-title":"Model averaged double robust estimation","volume":"73","author":"M Cefalu","year":"2017","journal-title":"Biometrics"},{"issue":"1","key":"pone.0310102.ref053","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1111\/biom.12736","article-title":"Covariate selection with group lasso and doubly robust estimation of causal effects","volume":"74","author":"B Koch","year":"2018","journal-title":"Biometrics"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0310102","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,13]],"date-time":"2024-09-13T17:36:17Z","timestamp":1726248977000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0310102"}},"subtitle":[],"editor":[{"given":"Yeong Jun","family":"Ju","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2024,9,13]]},"references-count":53,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2024,9,13]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0310102","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,13]]}}}