Race, community disadvantage, and cognitive decline: Findings from KHANDLE and STAR.

Abstract

Community disadvantage is associated with late-life cognition. Few studies examine its contribution to racial disparities in cognition/cognitive change. Inverse probability weighted models estimated expected mean differences in cognition/cognitive change attributed to residing in less advantaged communities, defined as cohort top quintile of Area Deprivation Indices (ADI): childhood 66-100; adulthood ADI 5-99). Interactions by race tested. More Black participants resided in less advantaged communities. Semantic memory would be lower if all participants had resided in less advantaged childhood (b=-0.16, 95% confidence interval [CI]=-0.30, -0.03) or adulthood (b=-0.14, 95% CI=-0.22, -0.04) communities. Race interactions indicated that, among Black participants, less advantaged childhood communities were associated with higher verbal episodic memory (interaction p-value=0.007) and less advantaged adulthood communities were associated with lower semantic memory (interaction p-value=0.002). Examining racial differences in levels of community advantage and late-life cognitive decline is a critical step toward unpacking community effects on cognitive disparities.