Association of Neighborhood-Level Disadvantage With Alzheimer Disease Neuropathology | Dementia and Cognitive Impairment | JAMA Network Open | JAMA Network
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    Original Investigation
    Public Health
    June 11, 2020

    Association of Neighborhood-Level Disadvantage With Alzheimer Disease Neuropathology

    Author Affiliations
    • 1Department of Medicine, Geriatrics Division, University of Wisconsin School of Medicine and Public Health, Madison
    • 2Health Services and Care Research Program, University of Wisconsin School of Medicine and Public Health, Madison
    • 3Department of Biostatistics & Medical Informatics, University of Wisconsin, Madison
    • 4Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison
    • 5Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison
    • 6Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison
    • 7Geriatric Research Education and Clinical Center (GRECC), William S. Middleton Hospital, United States Department of Veterans Affairs, Madison, Wisconsin
    • 8Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison
    • 9Department of Neurosciences, University of California, San Diego
    • 10Shiley-Marcos Alzheimer's Disease Research Center, University of California, San Diego, La Jolla
    JAMA Netw Open. 2020;3(6):e207559. doi:10.1001/jamanetworkopen.2020.7559
    Key Points español 中文 (chinese)

    Question  Can neighborhood disadvantage, a social determinant of health, be incorporated into existing brain bank data to evaluate the risk of biological outcomes, such as Alzheimer disease neuropathology?

    Findings  In this cross-sectional study using autopsy samples from 447 decedents, living in a disadvantaged neighborhood at the time of death was associated with an increased risk of presence of Alzheimer disease neuropathology when adjusting for age, sex, and year of death.

    Meaning  These findings suggest that neighborhood disadvantage can be geolinked to brain bank repositories and may be a marker for Alzheimer disease neuropathology.


    Importance  Social determinants of health, such as income, education, housing quality, and employment, are associated with disparities in Alzheimer disease and health generally, yet these determinants are rarely incorporated within neuropathology research.

    Objective  To establish the feasibility of linking neuropathology data to social determinants of health exposures using neighborhood disadvantage metrics (the validated Area Deprivation Index) and to evaluate the association between neighborhood disadvantage and Alzheimer disease–related neuropathology.

    Design, Setting, and Participants  This cross-sectional study consisted of decedents with a known home address who donated their brains to 1 of 2 Alzheimer disease research center brain banks in California and Wisconsin between January 1, 1990, and December 31, 2016. Neither site had preexisting social metrics available for their decedents. Neuropathologic features were obtained from each site for data collected using the standardized Neuropathology Data Set form and from autopsy reports. Data were analyzed from June 7 to October 10, 2019.

    Exposures  Geocoded decedent addresses linked to neighborhood disadvantage as measured by the Area Deprivation Index calculated for the year of death.

    Main Outcomes and Measures  Presence of Alzheimer disease neuropathology. The association between neighborhood disadvantage and Alzheimer disease neuropathology was evaluated via logistic regression, adjusting for age, sex, and year of death.

    Results  The sample consisted of 447 decedents (249 men [56%]; mean [SD] age, 80.3 [9.5] years; median year of death, 2011) spanning 24 years of donation. Fewer decedents (n = 24 [5.4%]) originated from the top 20% most disadvantaged neighborhood contexts. Increasing neighborhood disadvantage was associated with an 8.1% increase in the odds of Alzheimer disease neuropathology for every decile change on the Area Deprivation Index (adjusted odds ratio, 1.08; 95% CI, 1.07-1.09). As such, living in the most disadvantaged neighborhood decile was associated with a 2.18 increased odds of Alzheimer disease neuropathology (adjusted odds ratio, 2.18; 95% CI, 1.99-2.39).

    Conclusions and Relevance  The findings of this cross-sectional study suggest that social determinants of health data can be linked to preexisting autopsy samples as a means to study sociobiological mechanisms involved in neuropathology. This novel technique has the potential to be applied to any brain bank within the United States. To our knowledge, this is the first time Alzheimer disease neuropathology has been associated with neighborhood disadvantage.