Relationship between Residential Segregation, Later-Life Cognition, and Incident Dementia across Race/Ethnicity.
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ABSTRACT:
SUBMITTER: Pohl DJ
PROVIDER: S-EPMC8583156 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Prior research has reported disparities in environmental exposures in the United States, but, to our knowledge, no nationwide studies have assessed inequality in noise pollution.We aimed to a) assess racial/ethnic and socioeconomic inequalities in noise pollution in the contiguous United States; and b) consider the modifying role of metropolitan level racial residential segregation.We used a geospatial sound model to estimate census block group–level median (L50) nighttime and daytime noise exposure and 90th percentile (L10) daytime noise exposure. Block group variables from the 2006–2010 American Community Survey (ACS) included race/ethnicity, education, income, poverty, unemployment, homeownership, and linguistic isolation. We estimated associations using polynomial terms in spatial error models adjusted for total population and population density. We also evaluated the relationship between race/ethnicity and noise, stratified by levels of metropolitan area racial residential segregation, classified using a multigroup dissimilarity index.Generally, estimated nighttime and daytime noise levels were higher for census block groups with higher proportions of nonwhite and lower-socioeconomic status (SES) residents. For example, estimated nighttime noise levels in urban block groups with 75% vs. 0% black residents were 46.3 A-weighted decibels (dBA) [interquartile range (IQR): 44.3–47.8?dBA] and 42.3?dBA (IQR: 40.4–45.5?dBA), respectively. In urban block groups with 50% vs. 0% of residents living below poverty, estimated nighttime noise levels were 46.9?dBA (IQR: 44.7–48.5?dBA) and 44.0?dBA (IQR: 42.2–45.5?dBA), respectively. Block groups with the highest metropolitan area segregation had the highest estimated noise exposures, regardless of racial composition. Results were generally consistent between urban and suburban/rural census block groups, and for daytime and nighttime noise and robust to different spatial weight and neighbor definitions.We found evidence of racial/ethnic and socioeconomic differences in model-based estimates of noise exposure throughout the United States. Additional research is needed to determine if differences in noise exposure may contribute to health disparities in the United States. https://doi.org/10.1289/EHP898
| S-EPMC5744659 | biostudies-literature
Project description:BackgroundDementia is often underdiagnosed and this problem is more common among some ethnoracial groups.ObjectiveThe objective of this study was to examine racial and ethnic disparities in the timeliness of receiving a clinical diagnosis of dementia.Research designThis was a prospective cohort study.SubjectsA total of 3966 participants age 70 years and above with probable dementia in the Health and Retirement Study, linked with their Medicare and Medicaid claims.MeasuresWe performed logistic regression to compare the likelihood of having a missed or delayed dementia diagnosis in claims by race/ethnicity. We analyzed dementia severity, measured by cognition and daily function, at the time of a dementia diagnosis documented in claims, and estimated average dementia diagnosis delay, by race/ethnicity.ResultsA higher proportion of non-Hispanic Blacks and Hispanics had a missed/delayed clinical dementia diagnosis compared with non-Hispanic Whites (46% and 54% vs. 41%, P<0.001). Fully adjusted logistic regression results suggested more frequent missed/delayed dementia diagnoses among non-Hispanic Blacks (odds ratio=1.12; 95% confidence interval: 0.91-1.38) and Hispanics (odds ratio=1.58; 95% confidence interval: 1.20-2.07). Non-Hispanic Blacks and Hispanics had a poorer cognitive function and more functional limitations than non-Hispanic Whites around the time of receiving a claims-based dementia diagnosis. The estimated mean diagnosis delay was 34.6 months for non-Hispanic Blacks and 43.8 months for Hispanics, compared with 31.2 months for non-Hispanic Whites.ConclusionsNon-Hispanic Blacks and Hispanics may experience a missed or delayed diagnosis of dementia more often and have longer diagnosis delays. When diagnosed, non-Hispanic Blacks and Hispanics may have more advanced dementia. Public health efforts should prioritize racial and ethnic underrepresented communities when promoting early diagnosis of dementia.
| S-EPMC8263486 | biostudies-literature
Project description:Background/aimsAccumulating evidence suggests a link between non-alcoholic fatty liver disease (NAFLD) and brain health. However, population-based evidence on the association between NAFLD and dementia remains unclear. This study was conducted to determine the association between NAFLD and incident dementia.MethodsThe study population included 608,994 adults aged ≥60 years who underwent health examinations between 2009 and 2010. Data were collected from the Korean National Health Insurance Service database. NAFLD was assessed using the fatty liver index (FLI). A Cox proportional hazards regression model was used to determine the association between NAFLD and dementia.ResultsDuring the 6,495,352 person-years of follow-up, 48,538 participants (8.0%) developed incident dementia. The participants were classified into low (FLI <30), intermediate (FLI ≥30 and <60), and high (FLI ≥60) groups. In the overall study population, the FLI groups were associated with a risk of dementia (P for trend <0.001). After propensity score matching, a low FLI was associated with a reduced risk of dementia (adjusted hazard ration [aHR], 0.96; 95% confidence interval [CI], 0.93-0.98; P=0.002), whereas a high FLI (NAFLD) was associated with an increased risk of dementia (aHR, 1.05; 95% CI, 1.02-1.08; P=0.001). A higher risk of dementia in the high FLI group than in the intermediate FLI group was attributed to Alzheimer's disease (aHR, 1.04; 95% CI, 1.01-1.07; P=0.004) rather than vascular dementia (aHR, 0.94; 95% CI, 0.75-1.18; P=0.602).ConclusionNAFLD was associated with an increased risk of dementia, which was attributed to an increased risk of Alzheimer's disease.
| S-EPMC9293607 | biostudies-literature
Project description:Adverse health outcomes caused by extreme heat represent the most direct human health threat associated with the warming of the Earth's climate. Socioeconomic, demographic, health, land cover, and temperature determinants contribute to heat vulnerability; however, nationwide patterns of residential and race/ethnicity disparities in heat vulnerability in the United States are poorly understood. This study aimed to develop a Heat Vulnerability Index (HVI) for the United States; to assess differences in heat vulnerability across geographies that have experienced historical and/or contemporary forms of marginalization; and to quantify HVI by race/ethnicity. Principal component analysis was used to calculate census tract level HVI scores based on the 2019 population characteristics of the United States. Differences in HVI scores were analyzed across the Home Owners' Loan Corporation (HOLC) "redlining" grades, the Climate and Economic Justice Screening Tool (CEJST) disadvantaged versus non-disadvantaged communities, and race/ethnicity groups. HVI scores were calculated for 55,267 U.S. census tracts. Mean HVI scores were 17.56, 18.61, 19.45, and 19.93 for HOLC grades "A"-"D," respectively. CEJST-defined disadvantaged census tracts had a significantly higher mean HVI score (19.13) than non-disadvantaged tracts (16.68). The non-Hispanic African American or Black race/ethnicity group had the highest HVI score (18.51), followed by Hispanic or Latino (18.19). Historically redlined and contemporary CEJST disadvantaged census tracts and communities of color were found to be associated with increased vulnerability to heat. These findings can help promote equitable climate change adaptation policies by informing policymakers about the national distribution of place- and race/ethnicity-based disparities in heat vulnerability.
| S-EPMC9744626 | biostudies-literature
Project description:ObjectiveThe association of pregnancy with later-life cognition is not well understood. We examined whether full-term and incomplete pregnancies were associated with cognition in a sample of postmenopausal women, and whether socioeconomic status (SES) factors mediated these relationships.MethodsA total of 1016 cognitively normal women from the National Health and Nutrition Examination Survey (NHANES) were examined. Cognitive measures included the Digit Symbol Substitution Test (DSST), Animal Fluency (AF) and the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Word Learning (CERAD-WL) and Delayed Recall (CERAD-DR) tasks. Analyses examined the relationship between the number of term and incomplete pregnancies with cognitive performance, as well as the mediating effects of education and the federal income-to-poverty ratio (PIR).ResultsA greater number of term pregnancies was associated with worse performance on the DSST (β = -0.09, 95% confidence interval [CI]: -0.12, -0.06), AF (β = -0.03, 95% CI: -0.07, 0.00) and CERAD-DR (β = -0.04, 95% CI: -0.08, -0.01). More incomplete pregnancies were associated with better CERAD-DR performance (β = 0.07, 95% CI: 0.01, 0.13), and 28% (95% CI: 0.17, 0.42) of the association of term pregnancies with the DSST was mediated by the PIR.ConclusionsA higher number of term pregnancies was associated with worse cognitive performance, whereas a higher number of incomplete pregnancies was associated with better cognitive performance. Results indicate the necessity to consider SES factors when studying the relationship between pregnancy and cognition.
| S-EPMC9926890 | biostudies-literature
Project description:Lewy body dementia is the third most common and costliest type of dementia. It is an umbrella term for dementia with Lewy bodies and Parkinson's disease dementia, both of which place a substantial burden on the person and society. Recent findings outline ethnoracial differences in dementia risk. Delayed and misdiagnosis across ethnoracial groups contribute to higher levels of burden. In this context, we aimed to summarize current knowledge, gaps, and unmet needs relating to race and ethnicity in Lewy body dementia. In this narrative review, we provide an overview of studies on Lewy body dementia focusing on differences across ethnoracial groups and outline several recommendations for future studies. The majority of the findings comparing different ethnoracial groups were from North American sites. There were no differences in clinical prevalence and progression across ethnoracial groups. Compared to people identifying as non-Hispanic White, co-pathologies were more common and clinical diagnostic accuracy was lower for people identifying as Black. Co-morbidities (e.g., diabetes, hypertension) were more common and medication use rates (e.g., antidepressants, antiparkinsonian agents) were lower for people identifying as Black or Hispanic compared to people identifying as White. More than 90% of clinical trial participants identified as non-Hispanic White. Despite increasing efforts to overcome disparities in Alzheimer's disease and related dementias, inclusion of individuals from minoritized communities in Lewy body dementia studies continues to be limited and the findings are inconclusive. Representation of diverse populations is crucial to improve the diagnostic and therapeutic efforts in Lewy body dementia.
| S-EPMC10448838 | biostudies-literature
Project description:Race disparities in cardiovascular disease (CVD) related morbidity and mortality are evident among men. While previous studies show health in young adulthood and racial residential segregation (RRS) are important factors for CVD risk, these factors have not been widely studied in male populations. We sought to examine race differences in ideal cardiovascular health (CVH) among young men (ages 24-34) and whether RRS influenced this association. We used cross-sectional data from young men who participated in Wave IV (2008) of the National Longitudinal Survey of Adolescent to Adult Health (N = 5080). The dichotomous outcome, achieving ideal CVH, was defined as having ≥4 of the American Heart Association's Life's Simple 7 targets. Race (Black/White) and RRS (proportion of White residents in census tract) were the independent variables. Descriptive and multivariate analyses were conducted. Young Black men had lower odds of achieving ideal CVH (OR = 0.67, 95% CI = 0.49, 0.92) than young White men. However, RRS did not have a significant effect on race differences in ideal CVH until the proportion of White residents was ≥55%. Among young Black and White men, RRS is an important factor to consider when seeking to understand CVH and reduce future cardiovascular risk.
| S-EPMC8345482 | biostudies-literature
Project description:BackgroundExposure to systemic racism is linked to increased dementia burden. To assess systemic inflammation as a potential pathway linking exposure to racism and dementia disparities, we investigated the mediating role of C-reactive protein (CRP), a systemic inflammation marker, and the moderating role of race/ethnicity on racialized disparities in incident dementia.MethodsIn the US Health and Retirement Study (n=5,143), serum CRP was measured at baseline (2006, 2008 waves). Incident dementia was classified by cognitive tests over a six-year follow-up. Self-reported racialized categories were a proxy for exposure to the racialization process. We decomposed racialized disparities in dementia incidence (non-Hispanic Black and/or Hispanic vs. non-Hispanic White) into 1) the mediated effect of CRP, 2) the moderated portion attributable to the interaction between racialized group membership and CRP, and 3) the controlled direct effect (other pathways through which racism operates).ResultsThe 6-year cumulative incidence of dementia was 15.5%. Among minoritized participants (i.e., non-Hispanic Black and/or Hispanic), high CRP levels (> 75 th percentile or 4.57μg/mL) was associated with 1.27 (95%CI: 1.01,1.59) times greater risk of incident dementia than low CRP ( < 4.57μg/mL). Decomposition analysis comparing minoritized versus non-Hispanic White participants showed that the mediating effect of CRP accounted for 2% (95% CI: 0%, 6%) of the racial disparity, while the interaction effect between minoritized group status and high CRP accounted for 12% (95% CI: 2%, 22%) of the disparity. Findings were robust to potential violations of causal mediation assumptions.ConclusionsSystemic inflammation mediates racialized disparities in incident dementia.
| S-EPMC10081405 | biostudies-literature
Project description:Discrimination is pernicious in many ways, but there are inconsistent findings regarding whether it is harmful to cognitive function in later life. To address the inconsistency, we use two closely related concepts of everyday discrimination to predict cognitive trajectories in a diverse sample. Using data from the Health and Retirement Study (HRS), we examine whether the frequency of discrimination, measured at baseline with six questions, is related to poorer cognitive function and change in function over time (2008-2016). Age at baseline ranged from 53 to 100. Growth curve models of initial cognitive function and change in function were estimated. Everyday global discrimination was associated with poorer initial cognition and slower declines over time, and these relationships were not moderated by race and ethnicity. By contrast, the relationship between everyday racial discrimination and cognition was moderated by race: more frequent everyday racial discrimination was associated with better initial cognitive function among Black adults but not among Hispanic and White adults. Discrimination is a multifaceted concept, and specific types of discrimination manifest lower or higher cognitive function during later life for White, Black, and Hispanic adults.
| S-EPMC10599523 | biostudies-literature
Project description:IntroductionLung cancer incidence is higher among non-Hispanic (NH) blacks than among the NH white and Hispanic populations in the United States. However, national cancer estimates may not always reflect the cancer burden in terms of disparities and incidence in small geographic areas, especially urban-rural disparities. Moreover, there is a gap in the literature regarding rural-urban disparities in terms of cancer histologic type.MethodsUsing population-based cancer registry data-Surveillance, Epidemiology and End Results and National Program of Cancer Registries data-we present age-adjusted histologic rates and trends by race/ethnicity and residential county location at the time of first cancer diagnosis. Rate ratios were calculated to examine racial/ethnic differences in rates. Annual percent change was calculated to measure changes in rates over time.ResultsWe found that declines in squamous cell carcinoma are occurring fastest in metropolitan counties, whereas rates of adenocarcinoma increased fastest in counties nonadjacent to metropolitan areas. Further, although NH black men have increased lung cancer incidence compared with NH white and Hispanic men in all geographic locations, we found that the degree of the disparity increases with increasing rurality of residence. Finally, we discovered that among women whose lung cancer was diagnosed when they were younger than 55 years, the incidence of squamous cell carcinoma and adenocarcinoma was higher for NH blacks than for NH whites.ConclusionsOur results highlight disparities among NH blacks in nonadjacent rural areas. These findings may have significant impact for the implementation of smoking cessation and lung cancer screening programs.
| S-EPMC5884169 | biostudies-literature