2362-P: Prediabetes and Cognitive Impairment: The Influence of Social Risk Factors, HRS 2006–2016

Introduction and Objective: Prediabetes affects 38% of U.S. adults and has been associated with cognitive impairment/dementia. Social risk factors may shape this association, but evidence on their role as effect modifiers is limited. Methods: We analyzed longitudinal data from the Health and Retirement Study (2006-2016) among adults aged ≥18 years with biomarker-defined prediabetes (HbA1c 5.7-6.4%) and no prior diagnosis of diabetes/stroke. Cognitive status was classified using the Langa-Weir algorithm. Social risks factors were assessed across Healthy People 2030 domains, including economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context. Generalized mixed-effects logistic regression models and random intercepts for participants were used to examine associations between prediabetes and cognitive impairment/dementia over time. Interaction terms between prediabetes and social risk factors were tested in adjusted models. Significant interactions were observed for economic stability (difficulty paying bills, employment adversity), and education access and quality (< high school). Stratified analyses were conducted for these social risk factors, adjusting for demographics and comorbidities. Results: The analytic sample included 11,943 participants (mean age 64.7 ± 11.0 years; 60% female). Prediabetes was associated with higher odds of cognitive impairment/dementia among individuals without difficulty paying bills (aOR = 1.76; 95% CI: 1.33-2.34), without employment adversity (aOR = 1.43; 95% CI: 1.13-1.89), and with at least a high school education (aOR = 1.46; 95% CI: 1.13-1.89). Prediabetes was not significantly associated with cognitive impairment among individuals experiencing financial strain, employment adversity, or less than high school education. Conclusion: Stronger associations between prediabetes and cognitive impairment/dementia were observed among individuals without economic instability or educational disadvantage. Disclosure O. Ekwunife: None. Y. Xu: None. R. Fraser: None. J.A. Campbell: None. R.J. Walker: None. L.E. Egede: None. Funding National Institute of Diabetes and Digestive Kidney Disease (R01DK118038, R01DK120861, PI: Egede; K01DK131319, PI: Campbell), National Institute for Minority Health and Health Disparities (R01MD013826, PI: Egede/Walker, R01MD018012, R01MD017574, PI: Egede/Linde, R01MD018721, PI: Walker)