Legaz Agustina, Altschuler Florencia, Gonzalez-Gomez Raul, Hernández Hernán, Baez Sandra, Migeot Joaquín, Fittipaldi Sol, Medel Vicente, Maito Marcelo Adrián, Godoy María E, Moguilner Sebastián, Cruzat Josephine, Coronel-Oliveros Carlos, Tagliazuchi Enzo, Santamaria Garcia Hernando, Farina Francesca R, Reyes Pablo, Javandel Shireen, García Adolfo M, Deleglise Álvaro, Matallana Diana L, Avila-Funes José Alberto, Slachevsky Andrea, Behrens María I, Custodio Nilton, Trujillo-Llano Catalina, Cardona Juan F, Barttfeld Pablo, Brusco Ignacio L, Bruno Martín A, Sosa Ortiz Ana L, Pina-Escudero Stefanie D, Takada Leonel T, França Resende Elisa de Paula, Possin Katherine L, Okada de Oliveira Maira, Hu Kun, Lopera Francisco, Lawlor Brian, Valcour Victor, Yokoyama Jennifer S, Miller Bruce, Ibañez Agustin
Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibañez, Santiago de Chile, Chile.
Cognitive Neuroscience Center, Universidad de San Andres, Buenos Aires, Argentina.
Nat Aging. 2025 Feb;5(2):259-274. doi: 10.1038/s43587-024-00781-2. Epub 2024 Dec 27.
Structural inequality, the uneven distribution of resources and opportunities, influences health outcomes. However, the biological embedding of structural inequality in aging and dementia, especially among underrepresented populations, is unclear. We examined the association between structural inequality (country-level and state-level Gini indices) and brain volume and connectivity in 2,135 healthy controls, and individuals with Alzheimer's disease and frontotemporal lobe degeneration from Latin America and the United States. Greater structural inequality was linked to reduced brain volume and connectivity, with stronger effects in Latin America, especially in the temporo-cerebellar, fronto-thalamic and hippocampal regions. In the United States, milder effects were observed in the insular-cingular and temporal areas. Results were more pronounced in Alzheimer's disease and were independent of age, sex, education, cognition and other confounding factors. The findings highlight the critical role of structural inequality in aging and dementia, emphasizing the biological embedding of macrosocial factors and the need for targeted interventions in underserved populations.
结构性不平等，即资源和机会的不均衡分配，会影响健康结果。然而，结构性不平等在衰老和痴呆症中的生物学嵌入情况，尤其是在代表性不足的人群中，尚不清楚。我们研究了结构性不平等（国家层面和州层面的基尼指数）与2135名健康对照者以及来自拉丁美洲和美国的阿尔茨海默病和额颞叶痴呆患者的脑容量和脑连接性之间的关联。更大程度的结构性不平等与脑容量和脑连接性降低有关，在拉丁美洲影响更强，尤其是在颞小脑、额丘脑和海马区域。在美国，在岛叶扣带回和颞叶区域观察到的影响较轻微。结果在阿尔茨海默病中更为明显，且独立于年龄、性别、教育程度、认知和其他混杂因素。这些发现凸显了结构性不平等在衰老和痴呆症中的关键作用，强调了宏观社会因素的生物学嵌入以及对服务不足人群进行有针对性干预的必要性。
