Socioeconomic Status Explains Sex Differences on the Trail Making Test: The Case of the Epirus Health Study Cohort...

Socioeconomic (SES) and health status (HS) are rarely considered when normative data are calculated. In the present study, normative data for the Trail Making Test (TMT) were developed from a large cohort and the association of sex, age and education, as well as HS and SES, with direct and derived TMT scores was explored.

Two thousand three hundred sixteen participants [1412 (61%) women; mean age: 47.11 (SD = 11.67) years; mean education: 14.82 (SD = 3.39) years] were drawn from the population-based Epirus Health Study. HS was rated on a self-reported scale and participants' medical conditions were recorded. SES was estimated from participants' after-tax income per month. The association of sex, age and education with TMT-A, TMT-B, TMT B-A and TMT B/A was explored with linear regression analyses. Hierarchical regression analyses were applied to control for HS and SES.

Direct TMT scores were associated with sex, age and education (TMT-A: Bsex = 0.060, Bage = 0.322 and Beducation = -0.191; ΤΜΤ-Β: Bsex = 0.042, Bage = 0.330 and Beducation = -0.208). TMT B-A was associated with age (B = 0.176) and education (B = -0.130), whereas TMT B/A was not associated with any tested variable. SES, but not HS, was associated with TMT-A and TMT-B explaining the association of sex with TMT scores when included simultaneously in the model.

TMT performances are associated with age, education and sex. However, sex differences in direct TMT scores are attributed to underlying socioeconomic disparities in this large well-characterized cohort.