Hamlin Abbey M, Weigand Alexandra J, Clay Olivio J, Marsiske Michael, Wallace Gail, Dadson Deborah, Thomas Kelsey R, Clark Alexandra L
Department of Psychology, The University of Texas at Austin, Austin, Texas, USA.
Department of Psychiatry, University of California San Diego School of Medicine, La Jolla, California, USA.
J Gerontol B Psychol Sci Soc Sci. 2025 Jan 17;80(2). doi: 10.1093/geronb/gbae196.
Social and structural determinants of health (SSDoH) have been linked to racial disparities in Alzheimer's disease and related dementias (ADRD). Research has established that living in an environment with greater economic stability (ES) or healthcare access (HCA) is associated with better baseline cognition, but the interactive effects between these distinct SSDoH on cognition over time have not been studied. Therefore, the present study examined the independent and interactive effects of ES and HCA on 10-year change in cognitive functioning within a large sample of racially diverse community-dwelling older adults.
Participants included 701 Black/African American and 1804 White older adults from the Advanced Cognitive Training for Independent and Vital Elderly study. Multilevel mixed effects models were used to assess associations between ES and HCA factors on individual-level memory and reasoning trajectories.
Results revealed there was no significant ES × HCA interaction on longitudinal cognitive trajectories across the whole sample or within race-stratified groups, but there was a significant interaction on memory level. Higher ES levels were independently associated with slower age-related memory declines among Black/African American older adults. In contrast, higher ES and HCA levels were both independently associated with faster age-related reasoning declines among White participants.
Results demonstrated that ES and HCA exerted synergistic effects on memory level across ages in the whole sample. Differential associations between SSDoH and cognitive outcomes across racial groups suggest that improving access to economic resources within Black/African American communities may reduce racial disparities in ADRD.
健康的社会和结构决定因素（SSDoH）与阿尔茨海默病及相关痴呆症（ADRD）的种族差异有关。研究表明，生活在经济稳定性（ES）更高或医疗保健可及性（HCA）更好的环境中与更好的基线认知相关，但这些不同的SSDoH随时间推移对认知的交互作用尚未得到研究。因此，本研究在大量种族多样化的社区居住老年人样本中，考察了ES和HCA对认知功能10年变化的独立和交互作用。
参与者包括来自“独立和活力老年人高级认知训练”研究的701名黑人/非裔美国老年人和1804名白人老年人。使用多层次混合效应模型来评估ES和HCA因素与个体水平的记忆和推理轨迹之间的关联。
结果显示，在整个样本或种族分层组中，ES×HCA对纵向认知轨迹没有显著交互作用，但在记忆水平上存在显著交互作用。较高的ES水平与黑人/非裔美国老年人中与年龄相关的记忆衰退较慢独立相关。相比之下，较高的ES和HCA水平均与白人参与者中与年龄相关的推理衰退较快独立相关。
结果表明，ES和HCA在整个样本中对各年龄段的记忆水平发挥了协同作用。不同种族群体中SSDoH与认知结果之间的差异关联表明，改善黑人/非裔美国社区的经济资源获取可能会减少ADRD中的种族差异。
