Decomposing Racial and Ethnic Disparities in Risk and Protective Factors of Dementia in the U.S.

OBJECTIVES

This study investigates racial/ethnic disparities in dementia risk and protective factors using data from the Health and Retirement Study (HRS) and the Harmonized Cognitive Assessment Protocol (HCAP).

METHODS

A retrospective analysis of 3,495 individuals aged 65+ from the 2016 HCAP linked to the HRS was conducted. Cognitive status was assessed using the Mini-Mental State Examination (MMSE) scores. Risk factors included midlife cardiovascular conditions, hearing loss, current smoking, depression, and physical inactivity. Protective factors were education and wealth. The Oaxaca-Blinder decomposition method was used to quantify the contribution of these factors in explaining racial/ethnic disparities in cognitive functioning.

RESULTS

Black participants had 2.883 times higher odds of developing dementia compared to Whites, while Hispanic participants had 1.230 times higher odds (not statistically significant). Mid- and late-life risk and protective factors explained 32% of the cognitive gap between Black and White participants, and 70% between Hispanic and White participants, leaving 68% and 30% unexplained, respectively.

CONCLUSIONS

Addressing disparities in education, wealth, cardiovascular risks, depression, and hearing loss can reduce cognitive dysfunction in older adults.

CLINICAL IMPLICATIONS

Clinicians should target modifiable risk factors like depression and physical inactivity, particularly in minority populations. Addressing socioeconomic disparities is also crucial for improving cognitive health.