[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 34.204.168.209. Please contact the publisher to request reinstatement.
[Skip to Content Landing]
Views 1,420
Citations 0
Original Investigation
May 4, 2020

Association of Racial Residential Segregation Throughout Young Adulthood and Cognitive Performance in Middle-aged Participants in the CARDIA Study

Author Affiliations
  • 1Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
  • 2Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida
  • 3Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, Florida
  • 4Medical Scientist Training Program, Miller School of Medicine, University of Miami, Miami, Florida
  • 5Department of Health Research and Policy, Stanford University, Palo Alto, California
  • 6Department of Epidemiology and Biostatistics, University of California, San Francisco
  • 7Division of Epidemiology, Department of Preventative Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
  • 8Division of Research, Kaiser Permanente Northern California, Oakland
  • 9Department of Psychiatry, University of California, San Francisco
  • 10Department of Neurology, University of California, San Francisco
  • 11Neuroepidemiology Section, Intramural Research Program, National Institute on Aging, Bethesda, Maryland
  • 12Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
JAMA Neurol. Published online May 4, 2020. doi:10.1001/jamaneurol.2020.0860
Key Points

Question  Is cumulative exposure to residential segregation in young adulthood associated with midlife cognitive performance among black individuals in the US?

Findings  This cohort study of 1568 black participants in the Coronary Artery Risk Development in Young Adults study found that relative to living in low-segregation neighborhoods, black participants who were exposed to highly segregated neighborhoods in young adulthood exhibited worse performance in processing speed.

Meaning  The findings suggest that cumulative exposure to residential segregation is associated with poor cognitive performance among black individuals as early as midlife, which may explain black-white disparities in dementia risk at older age.

Abstract

Importance  Neighborhood-level residential segregation is implicated as a determinant for poor health outcomes in black individuals, but it is unclear whether this association extends to cognitive aging, especially in midlife.

Objective  To examine the association between cumulative exposure to residential segregation during 25 years of young adulthood among black individuals and cognitive performance in midlife.

Design, Setting, and Participants  The ongoing prospective cohort Coronary Artery Risk Development in Young Adults (CARDIA) Study recruited 5115 black and white participants aged 18 to 30 years from 4 field centers at the University of Alabama, Birmingham; University of Minnesota, Minneapolis; Northwestern University, Chicago, Illinois; and Kaiser Permanente, Oakland, California. Data were acquired from February 1985 to May 2011. Among the surviving CARDIA cohort, 3671 (71.8%) attended examination year 25 of the study in 2010, when cognition was measured, and 3008 (81.9%) of those completed the cognitive assessments. To account for time-varying confounding and differential censoring, marginal structural models using inverse probability weighting were applied. Data were analyzed from April 16 to July 20, 2019.

Main Outcomes and Measures  Racial residential segregation was measured using the Getis-Ord Gi* statistic, and the mean cumulative exposure to segregation was calculated across 6 follow-up visits from baseline to year 25 of the study, then categorized into high, medium, and low segregation. Cognitive function was measured at year 25 of the study, using the Digit Symbol Substitution Test (DSST), Stroop color test (reverse coded), and Rey Auditory Verbal Learning Test. To facilitate comparison of estimates, z scores were calculated for all cognitive tests.

Results  A total of 1568 black participants with available cognition data were included in the analysis. At baseline, participants had a mean (SD) age of 25 (4) years and consisted of 936 women (59.7%). Greater cumulative exposure to segregated neighborhoods was associated with a worse DSST z score (for high segregation, β = −0.37 [95% CI, −0.61 to −0.13]; for medium segregation, β = −0.25 [95% CI, −0.51 to 0.0002]) relative to exposure to low segregation.

Conclusions and Relevance  In this cohort study, exposure to residential segregation throughout young adulthood was associated with worse processing speed among black participants as early as in midlife. This association may potentially explain black-white disparities in dementia risk at older age.

Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    ×