The Area Deprivation Index: A novel tool for harmonizable risk assessment in Alzheimer's disease research

Abstract

Introduction: Residence in a disadvantaged neighborhood associates with adverse health exposures and outcomes, and may increase risk for cognitive impairment and dementia. Utilization of a publicly available, geocoded disadvantage metric could facilitate efficient integration of social determinants of health into models of cognitive aging.

Methods: Using the validated Area Deprivation Index and two cognitive aging cohorts, we quantified Census block-level poverty, education, housing, and employment characteristics for the neighborhoods of 2119 older adults. We assessed relationships between neighborhood disadvantage and cognitive performance in domains sensitive to age-related change.

Results: Participants in the most disadvantaged neighborhoods (n = 156) were younger, more often female, and less often college-educated or white than those in less disadvantaged neighborhoods (n = 1963). Disadvantaged neighborhood residence associated with poorer performance on tests of executive function, verbal learning, and memory.

Discussion: This geospatial metric of neighborhood disadvantage may be valuable for exploring socially rooted risk mechanisms, and prioritizing high-risk communities for research recruitment and intervention.

Keywords: cognition; cognitive aging; dementia; disparities; neighborhood disadvantage; social determinants.

FIGURE 1

Cognitive function factor score box plots by neighborhood disadvantage. ^aRey Auditory Verbal Learning Test (RAVLT) 1‐5, ^bRAVLT delayed, ^cTrail A (seconds), ^dTrail B (seconds); ADI, Area Deprivation Index. For RAVLT outcomes, higher scores indicate better cognitive function. For trailmaking outcomes, higher scores indicate poorer cognitive function. Outcomes adjusted for age, gender, race, education, parental history of dementia, and study cohort. Red is the 20% most disadvantaged group. Blue is the 80% least disadvantaged group. Color width is the density of observation points at that unit of measure