Socioeconomic and psychosocial mechanisms underlying racial/ethnic disparities in cognition among older adults.

Abstract

Objective: Racial/ethnic disparities in cognitive aging are only partly attributable to socioeconomic indicators. Psychosocial factors, such as discrimination and perceived control, also differ across racial/ ethnic groups, and emerging literature highlights their potential role in contributing to cognitive disparities in addition to socioeconomic status. Method: 1,463 older adults (51% Hispanic, 27% non-Hispanic Black, and 22% non-Hispanic White) in the Washington Heights-Inwood Columbia Aging Project completed cognitive and psychosocial measures, including a comprehensive neuropsychological battery, Everyday and Major Experiences of Lifetime Discrimination scales, and the Perceived Control scale. Mediation models quantified separate indirect effects of Black race and Hispanic ethnicity on global cognitive composite scores through education, income, discrimination, and external perceived control. Results: Educational attainment, income, and perceived control each mediated racial/ethnic disparities in global cognition. Socioeconomic indicators (i.e., lower education and lower income) explained approximately 50% of the Black-White and Hispanic-White disparities in global cognition, and more external perceived control explained an additional 5%-8%. Hispanics reported the lowest levels of discrimination, while non-Hispanic Blacks reported the highest levels. However, neither everyday nor major lifetime discrimination was associated with global cognition. Significant racial/ethnic disparities in global cognition remained after accounting for the included socioeconomic and psychosocial factors. Conclusions: This study suggests that psychosocial factors may explain racial/ethnic disparities in cognitive aging above and beyond socioeconomic indicators. More external perceived control, which could reflect chronic exposure to interpersonal and institutional marginalization, may be a particularly salient psychosocial risk factor for poorer cognitive aging among non-Hispanic Black and Hispanic older adults. Key PointsQuestion: What factors explain racial/ethnic inequalities in cognitive functioning among older adults? Findings: Lower socioeconomic status and lower perceived control each contribute independently to racial/ethnic inequalities in cognitive functioning. Importance: Targeting both economic and psychosocial factors may help to reduce racial/ethnic inequalities in cognitive aging. Next Steps: Future research should disentangle causal pathways to inequality involving socioeconomic and psychosocial factors, which may be interactive and/or bidirectional.

Diversity in Alzheimer's disease drug trials: The importance of eligibility criteria

“…60 Although this review specifically examined race/ethnicity, we acknowledge that race is a social construct and that health disparities are often driven by social determinants of health, such as education, literacy, socioeconomic status, racially patterned social stress, and access to care. [61][62][63] Although some trials in this review with race/ethnicity data reported the education level of the included participants, none mentioned SES. This limited reporting of social determinants of health is in line with a previous review in symptomatic treatment of AD, in which no studies reported on variables such as lifetime occupation, individual/household income, or wealth, and few studies on education.…”

“…Although this review specifically examined race/ethnicity, we acknowledge that race is a social construct and that health disparities are often driven by social determinants of health, such as education, literacy, socioeconomic status, racially patterned social stress, and access to care 61–63 . Although some trials in this review with race/ethnicity data reported the education level of the included participants, none mentioned SES.…”

The Development-Based Taxonomy of Stressors and Traumas: An Initial Empirical Validation

“…The research found that ethnic discrimination is a risk factor for psychotic disorders (Bardol et al, 2020). Discrimination's negative impacts on cognition in different age groups are well documented (e.g., Díaz-Venegas et al, 2016;Zahodne et al, 2021;Kira et al, 2020d).…”

Biopsychosocial pathways in dementia inequalities: Introduction to the Michigan Cognitive Aging Project.

“…In studies considering both discrimination and external control as separate, simultaneous mediators, external control has consistently emerged as a stronger contributor to racial inequalities in cognitive aging outcomes (Zahodne et al, 2017; Zahodne et al, 2021). In addition, external control shows much more reliable Latinx–White differences than discrimination (Zahodne, Sol & Kraal, 2019; Zahodne et al, 2021), as Latinx older adults often report less everyday discrimination than Whites (Lewis et al, 2012; Zahodne et al, 2021). This pattern of results might suggest that measures of external control capture the cognitively-relevant psychosocial experiences of marginalized social groups better than commonly-used measures of everyday discrimination.…”