Racial and Ethnic Differences in White Matter Hyperintensity Burden: The Role of Vascular Risk Factors

INTRODUCTION White matter hyperintensities (WMHs) are markers of cerebrovascular pathology associated with cognitive decline. Reports of racial and ethnic differences in WMH have been inconsistent across studies. This study examined whether race and ethnicity influence WMH burden and whether vascular risk factors explain these differences. METHODS Data from the National Alzheimer’s Coordinating Center included 7,132 Whites, 892 Blacks, 283 Asians, and 661 Hispanics. Baseline and longitudinal WMHs were examined using linear regression and mixed-effects models across racial and ethnic groups, controlling for demographics and vascular risk factors. RESULTS Adjusting for vascular risk factors reduced WMH burden differences and eliminated differences in temporal regions in Black vs White older adults. For Hispanics, differences became significant after adjusting for vascular risk factors. DISCUSSION While some racial and ethnic WMH disparities are influenced by vascular risk factors, others persist, highlighting the need for multidimensional approaches when targeting WMHs in diverse populations. Highlights Current research is inconsistent as to whether there are racial differences in WMHs Blacks exhibit higher WMH burden than Whites, mediated by vascular factors In Hispanics, WMH differences emerged only after adjusting for vascular risk factors