Mapping social determinants of cognitive health in Canada: a scoping review

Introduction We sought to map the literature assessing the associations between the social determinants of health (SDoH) and the cognitive health of adults in Canada. Methods We searched the Embase, CENTRAL, Global Health and MEDLINE databases through Ovid, from inception to 20 February 2024, for studies examining associations between SDoH and cognitive health among Canadian adults, irrespective of health or cognitive status. Results We identified 159 publications covering 93 studies; 27% (n = 25) had nationwide coverage and 48% (n = 45) were from Ontario or Quebec. Of the 410 associations between SDoH and cognition, 20 were from 6 qualitative studies and 390 from 87 quantitative studies. Education was the most frequently evaluated (46%) of the 29 identified SDoH categories, then social support (24%), household/individual income (19%), marital status (17%), occupation (16%), rural or urban area of residence (16%), living arrangement/household composition (12%) and environmental factors (13%). Two-thirds (67%) of the studies examined various cognitive health constructs, while 41% evaluated dementia (all types). Most of the SDoH were from the settings with which individuals directly interact. SDoH related to environmental exposure or pollution, societal norms, beliefs, values and practices were less frequently evaluated. Conclusion This scoping review provides a detailed map of the literature on SDoH and cognitive health in Canada. It highlights the importance of considering a comprehensive range of SDoH and of using diverse data sources and data collection approaches. The results also highlight SDoH that remain largely unexamined and should be prioritized in future research.