Relationship of daily, institutional and structural racism with cognition in ethnically/racially diverse middle‐age Americans

Abstract

AbstractBackgroundRacism is a social determinant of health that operates at multiple levels ‐ interpersonal, institutional, structural ‐ producing stress and limiting access to resources that have dire biopsychosocial effects for historically marginalized communities. Research on older adults suggests interpersonal and structural racism, separately, are associated with worse cognition and may be an underlying reason for racial/ethnic disparities in cognitive aging. An evidence gap remains on how multilevel racism influences cognition throughout the life‐course.MethodWe assessed 942 middle‐aged community‐dwelling adults (mean age = 55, SD = 11; 64% women; 19% non‐Latinx White; 23% non‐Latinx Black; 55% Latinx). Daily interpersonal racism was ascertained by the Everyday Discrimination (ED) scale, institutional racism by the Major Discrimination (MD) Scale, and structural racism in early life was measured by residential segregation of the census block group in which parents of our respondents lived. Our outcomes were derived from a neuropsychological evaluation with the Digit Span assessing attention and working memory, and delayed recall from the Selective Reminding Test capturing episodic memory. Two fluency measures (animal and letter) were also studied. The relationship between multilevel racism indicators and cognition was estimated using age‐adjusted linear regression models. Additional models were stratified by racialized/ethnic group and added education as a covariate.ResultExposure to multilevel racism varied across racialized/ethnic group. Non‐Latinx Black respondents scored highest on interpersonal racism, second highest on institutional racism, and were more likely to grow up in segregated residential areas with higher proportion of other Black residents. Exposure to interpersonal (Figure A) and institutional racism (Figure B) was associated with lower memory scores and these associations were driven by non‐Latinx Black respondents. Structural racism was associated with lower episodic memory in the full sample.ConclusionOur findings indicate that multilevel racism related to cognition and due to higher exposure among marginalized groups may be a substantial driver of racial/ethnic disparities in cognitive health. In future, additive and multiplicative effects of our exposures will be examined.