Racialized experience, biomarkers of lead exposure, and later-life cognition: a mediation analysis

Abstract We evaluated the role of the neurotoxicant lead (Pb) in mediating racial disparities in later-life cognition in 1085 non-Hispanic Black and 2839 non-Hispanic white participants in the National Health and Nutrition and Examination Survey (NHANES, 1999-2002, 2011-2014) 60+ years of age. We operationalized Black race as a marker for the experience of racialization and exposure to systemic racism. We estimated patella bone Pb via predictive models using blood Pb and demographics. Concurrent cognition (processing speed, sustained attention, working memory) was measured by the Digit Symbol Substitution Test (DSST) and a global measure combining 4 cognitive tests. To obtain the portion mediated, we used regression coefficients (race on Pb * Pb on cognitive score)/(race on cognitive score), adjusting for age, NHANES cycle, and sample weights. Other confounder adjustment (education, poverty income ratio, smoking) was limited to the mediator-outcome (ie, Pb-cognition) pathway because these factors do not lie upstream of race and so cannot confound associations with race. Lead was estimated to mediate 0.6% of the association between race and global cognition, and 4% of the DSST. Our results suggest that later-life cognitive health disparities may be impacted by avoidable lead exposure driven by environmental injustice, noting that a large proportion of the pathway of systemic racism harming cognition remains. This article is part of a Special Collection on Mental Health.