Aging
Redlining, race, and cognition within the Health and Retirement Study Jenna Rajczyk* Jeffrey Wing Jenna Rajczyk Julie Strominger Helen Meier
Introduction: Cognitive impairment and dementia burdens in the US are projected to rapidly increase with the growing aging population yet may not be equally shared for all race/ethnic groups. Differential distributions of resources and income by race/ethnicity may influence cognitive outcomes, where these unequal distributions attributed to structural racism have had major impacts on Black Americans.
Methods: Using Health and Retirement Study data, we evaluated the association between historic redlining index (calculated from Home Owners’ Lending Corporation security maps) and race on cognitive status cross-sectionally in 2016 and 2-year incident dementia or cognitive impairment not dementia (CIND). Weighted binary logistic regression modeled odds of dementia/CIND (Langa-Weir classification) compared to normal cognitive status, with the combination of race and redlining included in the model as a 4-level factor (reference: white-no redlining). Models were adjusted for age in 2016, education, gender, multimorbidity, marital status, and 2012-2016 neighborhood poverty level.
Results: Twenty percent of participants in 2016 (575/2133) had dementia or CIND. The association of redlining alone among white participants was negligible compared to white participants in non-redlined areas (OR: 0.86; 95% CI: 0.55, 1.34). However, Black participants in both non-redlined and redlined areas had more than twice the odds of having dementia/CIND compared to white participants in non-redlined areas (OR: 2.27; 95% CI:1.29, 3.97; OR: 2.23; 95% CI: 1.38, 3.63, respectively). Similar associations were observed with incident dementia/CIND.
Conclusions: Our findings elucidate the combined influence of individual-level race and residence in a historically redlined area on prevalent CIND/dementia, and the likely impact of redlining alone on incident CIND/dementia. The impact of historic redlining from nearly a century ago still has negative consequences on present day cognitive status.
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