Association of Neighborhood-Level Disadvantage With Alzheimer Disease Neuropathology

Abstract

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.

Teleneuropsychology clinic development and patient satisfaction

“…On average, patients in the teleNP group were residing in geographical neighborhoods with worse metrics on factors including income, education, employment and housing quality. Recent work has found a relationship between higher ADI scores and many outcomes including rates of rehospitalization, cerebral and hippocampal volume, and Alzheimer's disease neuropathology (Hu et al, 2018;Hunt et al, 2020;Powell et al, 2020). Increasing the availability and awareness of teleNP for those most at risk will allow patients to be diagnosed earlier, with important implications for treatment, managing disease progression, and improving quality of life.…”

Socioeconomic Status Mediates Racial Differences Seen Using theAT(N)Framework

“…Ethno-racial differences may be manifestations of lived experiences in either relative poverty or affluence rather than underlying biological or genetic factors, especially in the context of aging. 51,52 Therefore, gaining an accurate understanding of SES factors is critical in future studies. SES is considered a fundamental social cause of health because greater SES, especially at the neighborhood level, determines the context in which people reside, as well as the resources and risks, such as stress, poverty, and community-level violence, embedded in their context.…”

Neighborhood Disadvantage and Active, Disabled and Total Life Expectancy Among Community-living Older Persons

“…31 Addressing these and other disparities in resource-poor environments will require substantial investments to support a more robust set of social and public health interventions. 30,32 Based on the accumulating evidence linking socioeconomically disadvantaged neighborhoods to an increasing number of adverse health outcomes, [1][2][3][4] these investments could potentially lead to cost savings through large-scale reduction of inequalities in morbidity and mortality. 32,33 The outcomes evaluated in the current study, active and disabled life expectancy, are important not only to policy-makers, but also to older persons who consistently identify the maintenance of independent function as their top health outcome priority.…”

“…Prior research has shown that living in a socioeconomically disadvantaged neighborhood confers increased risk for several adverse outcomes including all-cause mortality, 1 hospital readmission, 2 the incidence and severity of delirium after major surgery, 3 and Alzheimer disease neuropathology. 4 Active and disabled life expectancy, defined as the projected number of remaining years without and with disability in activities of daily living, are often used by policy-makers to forecast the functional well-being of older persons. 5,6 Whether these longitudinal metrics of functional well-being are influenced by neighborhood disadvantage is unknown.…”

“…Prior research has shown that living in a socioeconomically disadvantaged neighborhood confers increased risk for several adverse outcomes including all-cause mortality, 1 hospital readmission, 2 the incidence and severity of delirium after major surgery, 3 and Alzheimer disease neuropathology. 4…”