Structural Gendered Racism

University Of California, San Francisco, San Francisco CA

Investigators

Abstract

Differences in the incidence and prevalence rates of Alzheimer’s disease and related dementias (ADRD) exist across demographic groups, and social disadvantage is hypothesized to be an important social determinant. Mounting evidence demonstrates that exposure to social disadvantage in early- and mid-life is associated with lower memory and neurocognitive performance in late life. To adequately intervene and reduce population level differences, it is essential to understand how different forms of disadvantage co-occur to affect the cognitive aging of those with heightened risk for incident dementia. Cognitive aging is strongly impacted by the social environment across the lifecourse and may be accelerated by early life exposures to cross-cutting forms of disadvantage. Among aging Black women, exposure to co-occurring disadvantage across the lifecourse may compound to accelerate cognitive decline and increase ADRD risk. This hypothesis has not been tested due to measurement limitations as well as reliance on between-group comparative study designs, which limit our understanding of the mechanistic processes that impact Black women and confer dementia risk. In response to this need, the scientific goal of this study is to use a mixed-methodological, within-group approach to: (1) develop and validate a multidimensional index of social disadvantage based on Black women’s lived experiences, (2) identify categorically distinct latent class profiles of social disadvantage across index dimensions, and (3) examine the associations of latent class profiles of early life exposure to social disadvantage with cognitive aging and ADRD risk. To achieve these aims, 56 Black women aged 50 or older across the United States will participate in qualitative interviews of their experiences of social disadvantage to identify relevant domains of influence (e.g., impacting access to housing). The PI will then conduct focus group interviews with research and data experts to determine metrics that capture each social disadvantage domain and identify corresponding datasets that will be leveraged to create a state-level social disadvantage index. This index will be linked to geographically coded data on early childhood from 4,793 Black women in the Health and Retirement Study (HRS) and their cognitive data collected over 24 years in late adulthood. These new data will be analyzed for latent classes of social disadvantage and the latent classes will be examined in relation to cognitive aging trajectories and ADRD risk. This study may illuminate mechanisms underlying Black women’s risk for ADRD and identify critical intervention points that can be addressed to reduce population-level difference in ADRD and improve the cognitive health of Black women. The research plan is complemented by training activities that build on the candidate’s background in neuropsychology and provide new training in (1) longitudinal and latent variable modeling; (2) social determinants of Black women’s cognitive aging; (3) mixed methods research; and (4) clinician-scientist leadership development.