Neighborhood disadvantage and the incidence of dementia in US Black women.

INTRODUCTION

We investigated the association of neighborhood disadvantage with the incidence of Alzheimer's disease and related dementias (ADRD) in the longitudinal Black Women's Health Study (BWHS).

METHODS

The study included 10,915 BWHS participants enrolled in Medicare for at least 1 year from 2012 to 2020. The Area Deprivation Index (ADI) was assigned to participant residential block groups over follow-up. ADRD cases were identified from Medicare files.

RESULTS

Age- and education-adjusted hazard ratios (HRs) for ADRD increased as neighborhood disadvantage increased, to 1.42 (95% confidence interval [CI] 1.06-1.91) in the most disadvantaged quintile compared to the least disadvantaged quintile, with a significant linear trend (p = 0.012). Associations remained, although somewhat attenuated, when individual income was controlled.

DISCUSSION

The present study adds to the evidence showing an association between living in a disadvantaged neighborhood and poorer brain health. The area-level association of deprivation with ADRD was in part explained by individual differences in socioeconomic status (SES).

HIGHLIGHTS

The study assessed neighborhood deprivation in the largest cohort of US Black women. Cases of dementia were ascertained from Medicare claims files over 9 years of follow-up. Higher levels of area deprivation were associated with higher dementia risk.