The association between neighborhood disadvantage and subjective cognitive functioning among Black women
Tanisha Hill-Jarrett1, Peter Buto2, M. Maria Glymour2, Lisa L Barnes3, Yvette Cozier2, Patricia Coogan2, Lynn Rosenberg2
1Neurology, Memory and Aging Center, University of California San Francisco, 2Boston University School of Public Health, 3Neurological Sciences, Rush University Medical Center
Objective:
We examined the association of multidimensional area deprivation index (ADI) with Black women’s self-reported cognitive functioning.
Background:
Black Americans have higher risk of cognitive impairment and are at nearly double the risk of Alzheimer’s disease and related dementias (ADRD) as other racial groups. Black women, existing at the intersection of both marginalized race and gender, may be at acute risk; however, the mechanisms underlying cognitive impairment remain poorly understood. Neighborhood-level exposures that are harmful to cognitive aging may be distinct for Black women given historical and contemporary structural racism and sexism and their influence on neighborhood environments. We hypothesized that Black women in more disadvantaged areas will have poorer subjective cognitive functioning.
Design/Methods:
Black Women’s Health Study participants (N=20,768) aged 55 and older (Mean= 64.6, Standard Deviation = 7.22) in 2015 completed six subjective cognitive function questions. ADI was calculated at the census block group level for 2015 using Singh’s method. We quantified associations between ADI and subjective cognitive functioning as a 3-level variable (good (0 problems, reference), moderate (1-2 problems), poor (3+ problems)) using multinomial logistic regression. Covariates included age, parental education, receipt of public assistance as a child (Model 1) and participant education (Model 2).
Results:
The multivariable odds ratio (OR, 95% confidence interval [CI]) for poor compared to good subjective cognitive function among Black women at the highest versus the lowest (reference) quintile of ADI was 1.21 ([95% CI: 1.02-1.42]) but this association was attenuated by adjustment for participant education (OR=1.07 [95% CI: 0.9-1.27]).
Conclusions:
ADI was associated with subjective cognitive function after adjustment for early life risk factors but not educational attainment. Neighborhood disadvantage reflects a potentially modifiable risk factor for cognitive impairment that can be addressed through public policy and advocacy. Additionally, education is a flexible resource that may outweigh some of the potential harms of neighborhood disadvantage.