The Independent and Interactive Effects of Economic Stability and Health Care Access on 10-Year Cognitive Trajectories of Black/African American and White Older Adults from the ACTIVE Study

Abbey M Hamlin; Alexandra J Weigand; Olivio J Clay; Michael Marsiske; Gail Wallace; Deborah Dadson; Kelsey R Thomas; Alexandra L Clark

doi:10.1093/geronb/gbae196

The Independent and Interactive Effects of Economic Stability and Health Care Access on 10-Year Cognitive Trajectories of Black/African American and White Older Adults from the ACTIVE Study

J Gerontol B Psychol Sci Soc Sci. 2024 Dec 12:gbae196. doi: 10.1093/geronb/gbae196. Online ahead of print.

Authors

Abbey M Hamlin¹, Alexandra J Weigand², Olivio J Clay^{3

4}, Michael Marsiske⁵, Gail Wallace^{6

7}, Deborah Dadson³, Kelsey R Thomas^{2

8}, Alexandra L Clark¹

Affiliations

¹ Department of Psychology, The University of Texas at Austin, Austin, Texas, USA.
² Department of Psychiatry, University of California San Diego School of Medicine, La Jolla, CA, USA.
³ Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA.
⁴ University of Alabama at Birmingham Alzheimer's Disease Research Center, Birmingham, AL, USA.
⁵ Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA.
⁶ Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁷ Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Baltimore, MD, USA.
⁸ VA San Diego Healthcare System, San Diego, CA, USA.

PMID: 39665593
DOI: 10.1093/geronb/gbae196

Abstract

Objectives: Social and structural determinants of health (SSDoH) have been linked to racial disparities in Alzheimer's disease and related dementias (ADRD). Research has established that living in an environment with greater economic stability (ES) or health care access (HCA) is associated with better baseline cognition, but the interactive effects between these distinct SSDoH on cognition over time have not been studied. Therefore, the present study examined the independent and interactive effects of ES and HCA on 10-year change in cognitive functioning within a large sample of racially diverse community-dwelling older adults.

Method: Participants included 701 Black/African American and 1,804 White older adults from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study. Multi-level mixed effects models were used to assess associations between ES and HCA factors on individual-level memory and reasoning trajectories.

Results: Results revealed there was no significant ES x HCA interaction on longitudinal cognitive trajectories across the whole sample or within race-stratified groups, but there was a significant interaction on memory level. Higher ES levels were independently associated with slower age-related memory declines among Black/African American older adults. In contrast, higher ES and HCA levels were both independently associated with faster age-related reasoning declines among White participants.

Discussion: Results demonstrated that ES and HCA exerted synergistic effects on memory level across ages in the whole sample. Differential associations between SSDoH and cognitive outcomes across racial groups suggest that improving access to economic resources within Black/African American communities may reduce racial disparities in ADRD.

Keywords: Alzheimer’s disease; Life Events and Contexts; Memory; Minority and Diverse Populations; Social Determinants of Health.

Published by Oxford University Press on behalf of the Gerontological Society of America 2024. This work is written by (a) US Government employee(s) and is in the public domain in the US.