Association of Racial Residential Segregation Throughout Young Adulthood and Cognitive Performance in Middle-aged Participants in the CARDIA Study
Open accessAbstract
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.
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Structural racism influences environmental factors, access to quality health care, employment prospects, occupational safety, wealth transfer, treatment by the legal system, and exposure to violence.
“Structural racism influences environmental factors such as where people can live, the quality of schools in their communities, and exposure to harmful toxicants and pollutants.It also influences access to quality health care, employment prospects, occupational safety, the ability to pass wealth to subsequent generations, treatment by the legal system and exposure to violence.”
From 2023 Alzheimer's disease facts and figures (2023) · cites this paper as [311]
The Introduction and Discussion link racial residential segregation to educational quality, the built environment, environmental exposures, poverty, and opportunities for socioeconomic mobility. They do not address the attributed claims about access to health care, occupational safety, intergenerational wealth transfer, treatment by the legal system, or exposure to violence (searched for these topics). (LLM, conf=0.88)
Experimental — accuracy not yet measuredSome studies indicate that early life experiences with residential and school segregation can have detrimental effects on the cognitive health of Black Americans in later life.
“some studies indicate that early life experiences with residential and school segregation can have detrimental effects on the cognitive health of Black Americans in later life.”
From 2023 Alzheimer's disease facts and figures (2023) · cites this paper as [311]
The Discussion reports that greater exposure to residential segregation during young adulthood was associated with worse processing speed in midlife among Black CARDIA participants. The paper discusses educational quality as a possible pathway, but it does not study school segregation or establish an effect on cognition in older age. (LLM, conf=0.86)
Experimental — accuracy not yet measuredSome studies indicate that early life experiences with residential and school segregation can have detrimental effects on the cognitive health of Black Americans in later life.
“For example, some studies indicate that early life experiences with residential and school segregation can have detrimental effects on the cognitive health of Black Americans in later life.”
From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [337]
The Results and Conclusions (page numbers unavailable) associate residential segregation during young adulthood with worse cognitive performance in midlife among Black participants. The paper discusses educational quality as a possible pathway, but does not study school segregation or establish an effect on cognition in later life. (LLM, conf=0.86)
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Bridging the Divide: Tackling Tensions Between Life-Course Epidemiology and Causal Inference
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- Authors
- Caunca, M. R., Odden, M. C., Glymour, M. M., Elfassy, T., Kershaw, K. N., Sidney, S., Yaffe, K., Launer, L., & Zeki Al Hazzouri, A.
- Affiliations
- University of Miami (US)
- Stanford University (US)
- University of California, San Francisco (US)
- Northwestern University (US)
- Kaiser Permanente (US)
- National Institutes of Health (US)
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
- ORCID
- Venue
- JAMA Neurology
- Publisher
- American Medical Association (AMA)
- Published
- 2020-08-01
- Volume
- 77
- Issue
- 8
- Pages
- 1000
- ISSN
- 2168-6149 (ISSN-L)
- PMC
- PMC7199173
- OpenAlex
- W3021828210
- Cited by
- 73
- References
- 61
- Citations by year
- 2026: 7 · 2025: 10 · 2024: 14 · 2023: 15 · 2022: 14 · 2021: 11 · 2020: 1 · 2019: 1
- FWCI
- 5.67
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Neurology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (HHSN268200900041C, HHSN268201300026C, HHSN268201300028C, HHSN268201300027C, KL2TR002737, HHSN268201300025C, AG0005, HHSN268201300029C)
- National Institute on Aging (R01AG063887, HHSN268201300029C, HHSN268201300026C, AG 0005, K01AG047273, HHSN268201300025C, HHSN268201300028C, HHSN268200900041C, HHSN268201300027C)
- National Heart, Lung, and Blood Institute (HHSN268201300028C, HHS-N2-68201300029C, HHSN268201300027C, HHSN268200900041C, HHSN268201300026C, HHS-N2-68201300025C, HHSN268201300025C, HHSN268201300026C, HHSN268201300027C, HHSN268201300028C, HHSN268201300029C, and HHSN268200900041C, and HHSN268200900041C, AG0005)
- National Institute of Neurological Disorders and Stroke (HHSN268200900041C, HHSN268201300028C, F30NS103462, HHSN268201300026C, HHSN268201300025C, HHSN268201300029C, HHSN268201300027C)
- National Center for Advancing Translational Sciences
- National Institute on Minority Health and Health Disparities (K01MD014158)
- Topics
- Social Sciences › Health › Health disparities and outcomes
- Social Sciences › Sociology and Political Science › Urban, Neighborhood, and Segregation Studies
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Keywords
- racial residential segregation, residential segregation, cognitive performance, cognitive aging, midlife cognition, early adulthood, cumulative exposure, Black people, CARDIA study, Digit Symbol Substitution Test, Stroop task, Rey Auditory Verbal Learning Test, Getis-Ord Gi*, neighborhood disadvantage, health disparities, risk factors for cognitive decline, social determinants of health
- MeSH terms
- Social Segregation, Adolescent, Adult, Black or African American, Female, Follow-Up Studies, Humans, Male, Middle Aged, Psychomotor Performance, Residence Characteristics, United States, White People, Health Status Disparities, Young Adult, Cognitive Dysfunction
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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