December 2, 2025Open Access

Association Between Structural and Social Determinants of Health and Cognitive Functioning Among African Americans: the ARCHES Cohort

Key Points

Cognitive impairment was observed in 33.7% of participants, influencing dementia risk and cognitive functioning.
Higher prevalence of cognitive impairment was found among those deprived on multiple social and structural indicators.
Multivariate regression models determined significant associations between cognitive impairment and various S/SDOH factors.
Supports improved public policies targeting education access and addressing structural racism to mitigate dementia risk.

Abstract

Abstract Background and Objectives Structural and social determinants of health (S/SDOH) are linked to dementia, yet despite Black Americans having a twofold dementia risk compared to Whites, research is limited. This study examined a new S/SDOH composite index (CI) based on the multidimensional poverty-adjusted headcount ratio and explored its association with potential cognitive impairment (PCI) or poor cognitive performance (PCP) among Black Americans. Research Design and Methods Participants were required to be age 45 or older, cognitively normal (CN), self-identified as Black or African American, and lived in the greater St. Louis, Missouri area at baseline. The S/SDOH-CI used 37 deprivation indicators from the National Institute on Aging Health Disparities Research Framework, covering environmental, sociocultural, and behavioral dimensions. Multivariate regression models were used to investigate associations between dementia and S/SDOH-CI. Results Among 312 Black adults, 105 (33.7%) had PCI, and 47 (15.1%) had PCP. A higher proportion of those with PCI or PCP were deprived on 11 indicators (22.9% and 23.4%, respectively), compared to CN adults (13% and 15.1%). The difference in S/SDOH-CI between Black adults with PCI/PCP and CN was 62.4% and 43.9%, respectively. Key contributors of S/SDOH-CI included social factors, detrimental health behaviors, limited education, healthcare barriers, and psychological factors. The S/SDOH-CI was strongly associated with PCI (odds ratio OR: 11.48; 95%CI 2.08-65.00) and PCP (OR: 13.84; 95%CI 1.27-152.07) after adjusting for sex, age, and marital status. The risk was higher for Black adults over 65 (OR, 1.90; 95%CI 1.14–3.22 for PCI and OR 6.49; 95%CI 2.84–16.85 for PCP). Conclusion These findings suggest that improving S/SDOH early in life for Black Americans through targeted public policies could reduce dementia risk later. This includes promoting equitable access to education and healthcare and implementing programs to reduce material hardship. The results also support policies that address structural racism and its impact on the health and well-being of Black Americans.

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