"Hang Ups, Let Downs, Bad Breaks, Setbacks": Impact of Structural Socioeconomic Racism and Resilience on Cognitive Change Over Time for Persons Racialized as Black.

Introduction: Older adults racialized as Black experience higher rates of dementia than those racialized as White. Structural racism produces socioeconomic challenges, described by artist Marvin Gaye as "hang ups, let downs, bad breaks, setbacks" that likely contribute to dementia disparities. Robust dementia literature suggests socioeconomic factors may also be key resiliencies. Methods: We linked state-level data reflecting the racialized landscape of economic opportunity across the 20th Century from the U.S. Census (1930-2010) with individual-level data on cognitive outcomes from the U.S. Health and Retirement Study participants racialized as Black. A purposive sample of participants born after the Brown v. Board ruling (born 1954-59) were selected who completed the modified Telephone Interview for Cognitive Status between 2010 and 2020 (N=1381). We tested associations of exposure to structural racism and resilience before birth, and during childhood, young-adulthood, and midlife with cognitive trajectories in mid-late life using mixed-effects regression models. Results: Older adults born in places with higher state-level structural socioeconomic racism experienced a more rapid cognitive decline in later life compared to those with lower levels of exposure. In addition, participants born in places with higher levels of state-level structural socioeconomic resilience experienced slower cognitive change over time than their counterparts. Discussion: These findings reveal the impact of racist U.S. policies enacted in the past that influence cognitive health over time and dementia risk later in life.

Education as the Great Equalizer? Racial and Ethnic Differences in the Effect of Education on Cognitive Impairment in Later Life.

Though evidence suggests that the prevalence of cognitive impairment has declined, there still exists a disproportionate burden of ill cognitive health for people of color. In this paper, we test two alternative mechanisms to explain the interactive effect of education and race/ethnicity on cognitive impairment risk: the minority poverty and diminishing returns hypotheses. Drawing on data from the 2012 wave of the Health and Retirement Study (HRS) (n = 8093), we estimate logistic regression models to determine differential effects of education on cognitive impairment. We find that non-Hispanic black and Mexican American older adults have higher odds of being cognitively impaired compared to whites, though the ethnic difference (whites vs. Mexican Americans) is mediated by education. Further, we find that while high levels of education are protective against cognitive impairment at older ages, it is more protective for non-Hispanic blacks than for whites and more protective for whites than Mexican Americans. Lastly, we find that racial/ethnic disparities are widest at lower levels of education, consistent with the minority poverty hypothesis. We conclude that the results herein highlight the importance of attending to how factors that are protective for cognitive functioning (e.g., education) may operate differently across racial and ethnic groups.

Gender and reinforcing associations between socioeconomic disadvantage and body mass over the life course.

Using the 1957-1993 data from the Wisconsin Longitudinal Study, we explore reciprocal associations between socioeconomic status (SES) and body mass in the 1939 birth cohort of non-Hispanic white men and women. We integrate the fundamental cause theory, the gender relations theory, and the life course perspective to analyze gender differences in (a) the ways that early socioeconomic disadvantage launches bidirectional associations of body mass and SES and (b) the extent to which these mutually reinforcing effects generate socioeconomic disparities in midlife body mass. Using structural equation modeling, we find that socioeconomic disadvantage at age 18 is related to higher body mass index and a greater risk of obesity at age 54, and that this relationship is significantly stronger for women than men. Moreover, women are more adversely affected by two mechanisms underlying the focal association: the obesogenic effect of socioeconomic disadvantage and the SES-impeding effect of obesity. These patterns were also replicated in propensity score-matching models. We conclude that gender and SES act synergistically over the life course to shape reciprocal chains of two disadvantaged statuses: heavier body mass and lower SES.