Abstract
BackgroundThe aim of the study was to examine the explanatory role of sociodemographic, clinical, behavioral, and social factors on racial/ethnic differences in cognitive decline among adults with diabetes.MethodsAdults aged 50+ years with diabetes from the Health and Retirement Survey were assessed for cognitive function (normal, mild cognitive impairment [MCI], and dementia). Generalized estimating equation (GEE) logistic regression models were used to account for repeating measures over time. Models were adjusted for sociodemographic (gender, age, education, household income and assets), behavioral (smoking), clinical (ie. comorbidities, body mass index), and social (social support, loneliness, social participation, perceived constraints and perceived mastery on personal control) factors.ResultsUnadjusted models showed non-Hispanic Blacks (NHB) and Hispanics were significantly more likely to progress from normal cognition to dementia (NHB OR: 2.99, 95%CI 2.35–3.81; Hispanic OR: 3.55, 95%CI 2.77–4.56), and normal cognition to MCI (NHB OR = 2.45, 95%CI 2.14–2.82; Hispanic OR = 2.49, 95%CI 2.13–2.90) compared to non-Hispanic Whites (NHW). Unadjusted models for the transition from mild cognitive decline to dementia showed Hispanics were more likely than NHW to progress (OR = 1.43, 95%CI 1.11–1.84).After adjusting for sociodemographic, clinical/behavioral, and social measures, NHB were 3.75 times more likely (95%CI 2.52–5.56) than NHW to reach dementia from normal cognition. NHB were 2.87 times more likely (95%CI 2.37–3.48) than NHW to reach MCI from normal. Hispanics were 1.72 times more likely (95%CI 1.17–2.52) than NHW to reach dementia from MCI.ConclusionClinical/behavioral and social factors did not explain racial/ethnic disparities. Racial/ethnic disparities are less evident from MCI to dementia, emphasizing preventative measures/interventions before cognitive impairment onset are important.
Highlights
Diabetes is one of the most common chronic diseases, affecting roughly 9.4% of the U.S population [1]
Racial/ethnic disparities are less evident from mild cognitive impairment (MCI) to dementia, emphasizing preventative measures/interventions before cognitive impairment onset are important
Cognitive deficits in older adults with diabetes show profound differences across different races and ethnicities; for example, non-Hispanic Blacks, Hispanics, Native Americans, and Mexican Americans have greater cognitive deficits over time compared to non-Hispanic Whites (NHW) [14,15,16,17,18,19,20]
Summary
Diabetes is one of the most common chronic diseases, affecting roughly 9.4% of the U.S population [1]. Racial/ ethnic minorities have higher rates of diagnosed diabetes than non-Hispanic Whites, which increases risks of. Diabetes has been associated with increased decline in cognitive functioning [2,3,4,5]. Diabetes may increase one’s risk for the progression from MCI to dementia, in addition to the increased risk of progression from normal cognition to dementia [9, 10]. Cognitive deficits in older adults with diabetes show profound differences across different races and ethnicities; for example, non-Hispanic Blacks, Hispanics, Native Americans, and Mexican Americans have greater cognitive deficits over time compared to non-Hispanic Whites (NHW) [14,15,16,17,18,19,20]. The aim of the study was to examine the explanatory role of sociodemographic, clinical, behavioral, and social factors on racial/ethnic differences in cognitive decline among adults with diabetes
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