Ethnoracial disparities in cognition are associated with multiple socioeconomic status-stress pathways

Letang, Sarah K.; Lin, Shayne S.-H.; Parmelee, Patricia A.; McDonough, Ian M.

doi:10.1186/s41235-021-00329-7

Cited by 20 publications

(11 citation statements)

References 97 publications

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“…Hence we also performed a multivariable logistic regression to use all available data. Although sociodemographic and comorbidity factors are interconnected with race and ethnicity as a result of structural racism and systemic inequality within the US, 42,43 these were treated as independent variables in the logistic regression model. Although we found lower proportions and odds of amyloid PET positivity for Asian and Hispanic participants, Black participants had significantly lower odds but no difference in proportion.…”

Section: Discussionmentioning

confidence: 99%

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Racial and Ethnic Differences in Amyloid PET Positivity in Individuals With Mild Cognitive Impairment or Dementia

et al. 2022

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ImportanceRacial and ethnic groups with higher rates of clinical Alzheimer disease (AD) are underrepresented in studies of AD biomarkers, including amyloid positron emission tomography (PET).ObjectiveTo compare amyloid PET positivity among a diverse cohort of individuals with mild cognitive impairment (MCI) or dementia.Design, Setting, and ParticipantsSecondary analysis of the Imaging Dementia–Evidence for Amyloid Scanning (IDEAS), a single-arm multisite cohort study of Medicare beneficiaries who met appropriate-use criteria for amyloid PET imaging between February 2016 and September 2017 with follow-up through January 2018. Data were analyzed between April 2020 and January 2022. This study used 2 approaches: the McNemar test to compare amyloid PET positivity proportions between matched racial and ethnic groups and multivariable logistic regression to assess the odds of having a positive amyloid PET scan. IDEAS enrolled participants at 595 US dementia specialist practices. A total of 21 949 were enrolled and 4842 (22%) were excluded from the present analysis due to protocol violations, not receiving an amyloid PET scan, not having a positive or negative scan, or because of small numbers in some subgroups.ExposuresIn the IDEAS study, participants underwent a single amyloid PET scan.Main Outcomes and MeasuresThe main outcomes were amyloid PET positivity proportions and odds.ResultsData from 17 107 individuals (321 Asian, 635 Black, 829 Hispanic, and 15 322 White) with MCI or dementia and amyloid PET were analyzed between April 2020 and January 2022. The median (range) age of participants was 75 (65-105) years; 8769 participants (51.3%) were female and 8338 (48.7%) were male. In the optimal 1:1 matching analysis (n = 3154), White participants had a greater proportion of positive amyloid PET scans compared with Asian participants (181 of 313; 57.8%; 95% CI, 52.3-63.2 vs 142 of 313; 45.4%; 95% CI, 39.9-50.9, respectively; P = .001) and Hispanic participants (482 of 780; 61.8%; 95% CI, 58.3-65.1 vs 425 of 780; 54.5%; 95% CI, 51.0-58.0, respectively; P = .003) but not Black participants (359 of 615; 58.4%; 95% CI, 54.4-62.2 vs 333 of 615; 54.1%; 95% CI, 50.2-58.0, respectively; P = .13). In the adjusted model, the odds of having a positive amyloid PET scan were lower for Asian participants (odds ratio [OR], 0.47; 95% CI, 0.37-0.59; P &lt; .001), Black participants (OR, 0.71; 95% CI, 0.60-0.84; P &lt; .001), and Hispanic participants (OR, 0.68; 95% CI, 0.59-0.79; P &lt; .001) compared with White participants.Conclusions and RelevanceRacial and ethnic differences found in amyloid PET positivity among individuals with MCI and dementia in this study may indicate differences in underlying etiology of cognitive impairment and guide future treatment and prevention approaches.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Racial and Ethnic Differences in Amyloid PET Positivity in Individuals With Mild Cognitive Impairment or Dementia

et al. 2022

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“…A key area for future investigation will be to examine how socioeconomic conditions create a context of biopsychosocial vulnerability and influence the risk of dementia at critical periods throughout the life course, including early and mid‐life. When considered within a historical context of structural racism that manifested as policy‐sanctioned residential segregation and concentrated impoverishment of racial and ethnic minorities, 54 these results strongly implicate neighborhood socioeconomic conditions as a means by which racial and ethnic differences in dementia risk are health inequities.…”

Section: Discussionmentioning

confidence: 99%

Racial, ethnic and neighborhood socioeconomic differences in incidence of dementia: A regional retrospective cohort study

Becerril

Pfoh

Hashmi

et al. 2023

J American Geriatrics Society

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Background Evidence on the effects of neighborhood socioeconomic disadvantage on dementia risk in racially and ethically diverse populations is limited. Our objective was to evaluate the relative extent to which neighborhood disadvantage accounts for racial/ethnic variation in dementia incidence rates. Secondarily, we evaluated the spatial relationship between neighborhood disadvantage and dementia risk. Methods In this retrospective study using electronic health records (EHR) at two regional health systems in Northeast Ohio, participants included 253,421 patients aged >60 years who had an outpatient primary care visit between January 1, 2005 and December 31, 2015. The date of the first qualifying visit served as the study baseline. Cumulative incidence of composite dementia outcome, defined as EHR‐documented dementia diagnosis or dementia‐related death, stratified by neighborhood socioeconomic deprivation (as measured by Area Deprivation Index) was determined by competing‐risk regression analysis, with non‐dementia‐related death as the competing risk. Fine‐Gray sub‐distribution hazard ratios were determined for neighborhood socioeconomic deprivation, race/ethnicity, and clinical risk factors. The degree to which neighborhood socioeconomic position accounted for racial/ethnic disparities in the incidence of composite dementia outcome was evaluated via mediation analysis with Poisson rate models. Results Increasing neighborhood disadvantage was associated with increased risk of EHR‐documented dementia diagnosis or dementia‐related death (most vs. least disadvantaged ADI quintile HR = 1.76, 95% confidence interval = 1.69–1.84) after adjusting for age and sex. The effect of neighborhood disadvantage on this composite dementia outcome remained after accounting for known medical risk factors of dementia. Mediation analysis indicated that neighborhood disadvantage accounted for 34% and 29% of the elevated risk for composite dementia outcome in Hispanic and Black patients compared to White patients, respectively. Conclusion Neighborhood disadvantage is related to the risk of EHR‐documented dementia diagnosis or dementia‐related death and accounts for a portion of racial/ethnic differences in dementia burden, even after adjustment for clinically important confounders.

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“…US-born Hispanics show lower cognitive function when compared with US-born non-Hispanic Whites and foreign-born Hispanics (79). Adverse socioeconomic environments can impact US-based Hispanics' cognitive health through limited access to educational and occupational opportunities, psychosocial stress, and systemic racism (80). Additionally, studies have shown US-based Hispanics are at higher risk of developing hypertension, obesity, and T2D, all of which can impair cognitive health (81).…”

Section: Discussionmentioning

confidence: 99%

A Cross-sectional Analysis of Food Perceptions, Food Preferences, Diet Quality, and Health in a Food Desert Campus

Aldaz

Ortiz

et al. 2022

Preprint

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The sensory properties of foods guide food choices and intake, importantly determining nutritional and health status. In communities that have inconsistent access to nutritious foods, such as food deserts, the food taste perceptions and preferences have yet to be explored. The paucity of data pertaining to food perceptions, preferences, and choices and the complex relationship of socioeconomic status (SES), race/ethnicity, and sex on cardiometabolic and cognitive health warrants further examination. Two hundred fifty participants (aged 18-24 years) living in a food desert campus were recruited for this cross-sectional study where participants underwent taste tests on selected fruits, vegetables, and nuts, and clinical tests (anthropometrics, blood glucose, blood pressure, and endothelial function), cognitive function tests (memory and attention), diet quality assessment (HEI), and food preference and perception assessments. Food taste intensities were influenced by sex with bitter and umami taste intensities of several foods being perceived more intensely by males. Moreover, food liking was largely influenced by ethnicity with Hispanics having higher liking ratings for several foods compared with non-Hispanics. Both, Hispanics and females, had higher total fruit HEI scores and lower attention scores than non-Hispanics and males respectively. Females also had lower blood pressure, reactive hyperemia index, and fasting blood glucose. Food-insecure individuals rated cost and convenience as more important factors for overall food consumption and had lower attention scores than those with higher food-security status. Future research should consider the complex interactions of factors such as taste and flavor perception, sex, ethnicity, prior exposure to foods, and other environmental factors when studying food preferences and health in young adults.

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Ethnoracial disparities in cognition are associated with multiple socioeconomic status-stress pathways

Cited by 20 publications

References 97 publications

Racial and Ethnic Differences in Amyloid PET Positivity in Individuals With Mild Cognitive Impairment or Dementia

Racial and Ethnic Differences in Amyloid PET Positivity in Individuals With Mild Cognitive Impairment or Dementia

Racial, ethnic and neighborhood socioeconomic differences in incidence of dementia: A regional retrospective cohort study

A Cross-sectional Analysis of Food Perceptions, Food Preferences, Diet Quality, and Health in a Food Desert Campus

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