Associations between structural/social determinants of health and vulnerability for and resilience against Alzheimer’s disease and related dementias: The Healthy Brain Initiative

Abstract

AbstractBackgroundStructural and social determinants of health (S/SDOH) encompass systems such as laws and policies and social constructs imposed by society such as race and class, as well as environmental conditions where people live, learn, work, and play. S/SDOH can significantly impact health throughout the life course by determining access to health promoting resources and opportunities, which in turn impacts modifiable risk factors (e.g., diet, physical activity, social contact) known to influence Alzheimer’s disease and related dementia (ADRD) risk. In this study, we investigate associations between multiple S/SDOH and measures of ADRD vulnerability and resilience among older adults.MethodWe used cross‐sectional data from the Comprehensive Center for Brain Health’s Healthy Brain Initiative (HBI), which is assembling a cohort of 45‐ to 85‐year‐olds with no or mild cognitive impairment (MCI); conducts comprehensive and harmonized clinical, cognitive, behavioral, and functional evaluations; and collects data on residential history and neighborhood perceptions. S/SDOH included the perceived discrimination index (range: 0‐22), area deprivation index (ADI) (range: 1‐99), perceived neighborhood greenspace (inadequate/adequate), and trust in neighbors (low/high). Linear regression (accounting for clustering by Census tract as appropriate) tested associations between the four S/SDOH measures and continuous Vulnerability Index (VI; range: 2‐13) and Resilience Index measures (RI; range: 105‐260). Models controlled for demographics and MCI (versus normal cognition).ResultParticipants (n = 111) were 69±10.5 years old, 62% women, 7% Black, 4% Asian, and 16% Hispanic. Twenty‐eight percent reported inadequate neighborhood greenspace and 16% reported low trust in neighbors. Mean discrimination scores were 5.5±6.7 and mean ADI scores were 30.2±25.9. Participants with higher ADI (estimate = 0.05, 95% CI: 0.02‐0.07), reporting higher discrimination (estimate = 0.15, 95% CI: 0.10‐0.21), and reporting neighborhoods lacking greenspace (estimate = 1.19, 95% CI = 0.38‐1.99) had higher VI scores. No other associations were observed.ConclusionThese preliminary results suggest that area deprivation, self‐reported lower amounts of neighborhood greenspace, and greater discrimination are associated with greater ADRD risk as measured by VI scores. Observed associations must be replicated with larger and more diverse samples and will be re‐evaluated as the HBI cohort accumulates (with ≥20 enrolling/month, expect ≥100 additional participants by mid‐2023) and compared with imaging and plasma ADRD biomarkers.