A Polysocial Approach in Exploring Racial and Ethnic Differences in Dementia and Cognitive Decline Among U.S. Older Adults: Health and Retirement Study

Yongjing Ping; Michelle C Odden; Xi Chen; Matthew Prina; Hanzhang Xu; Hao Xiang; Chenkai Wu

doi:10.1093/geroni/igae078

A Polysocial Approach in Exploring Racial and Ethnic Differences in Dementia and Cognitive Decline Among U.S. Older Adults: Health and Retirement Study

Innov Aging. 2024 Aug 28;8(10):igae078. doi: 10.1093/geroni/igae078. eCollection 2024.

Authors

Yongjing Ping^{1

2}, Michelle C Odden³, Xi Chen^{4

5}, Matthew Prina⁶, Hanzhang Xu^{1

7}, Hao Xiang^{8

9}, Chenkai Wu²

Affiliations

¹ Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.
² Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China.
³ Department of Epidemiology and Population Health, Stanford University, Stanford, California, USA.
⁴ Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA.
⁵ Department of Economics, Yale University, New Haven, Connecticut, USA.
⁶ Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
⁷ Department of Family Medicine and Community Health, School of Nursing, Duke University, Durham, North Carolina, USA.
⁸ Department of Global Health, School of Public Health, Wuhan University, Wuhan, Hubei, China.
⁹ Global Health Institute of Wuhan University, Wuhan University, Wuhan, Hubei, China.

Abstract

Background and objectives: The racial or ethnic disparity in the burden of dementia exists among older adults in the United States, whereas gaps remain in understanding the synergic effect of multiple social determinants of health on diminishing this disparity. We aim to build a polysocial score for dementia and investigate the racial or ethnic difference in dementia risk among older persons with different polysocial score categories.

Research design and methods: In this prospective cohort study, we utilized longitudinal data from the Health and Retirement Study in the United States recruiting 6 945 participants aged ≥65 years who had data on 24 social determinants of health in 2006/2008. The dementia status of participants was measured by a modified version of the Telephone Interview of Cognitive Status. The stepwise Cox regression was applied to select social determinants of health associated with incident dementia to construct a polysocial score. The multivariable Poisson model and linear mixed model were utilized to investigate the associations between polysocial score and incident dementia and cognitive decline, respectively.

Results: Eight social determinants of health were used to build the polysocial score. Non-Hispanic Black older participants had a higher incidence rate (incidence rate difference [IRD] = 22.7; 95% confident interval [95% CI] = 12.7-32.8) than non-Hispanic White older adults in the low polysocial score, while this difference was substantially attenuated in the high polysocial score category (IRD = 0.5; 95% CI = -6.4 to -7.5). The cognitive decline of non-Hispanic older Black adults with high polysocial score was 84.6% slower (averaged cognitive decline: non-Hispanic White: -2.4 [95% CI = -2.5 to -2.3] vs non-Hispanic Black: -1.3 [95% CI = -1.9 to -0.8]) than that of non-Hispanic older White persons.

Discussion and implications: These findings may help comprehensively understand and address racial and ethnic disparities in dementia risk and may be integrated into existing dementia prevention programs to provide targeted interventions for community-dwelling older adults with differentiated social disadvantages.

Keywords: Health disparities; Longitudinal data analysis; Social determinants of health.