Negative early life experiences, such as attending segregated schools, significantly contribute to cognitive decline and disparities between older Black and white Americans, according to a recent study led by researchers at the Yale School of Public Health and published in JAMA Internal Medicine. This study breaks new ground by focusing on the duration of schooling, the quality of education, and personal experiences during schooling, including exposure to segregated environments, marking it as a landmark contribution to understanding these dynamics.
Lead author Xi Chen, associate professor of public health at Yale School of Public Health, underscores the study’s importance amidst stark disparities in dementia rates between Black and white Americans. According to the Alzheimer’s Association, Black older adults are about twice as likely as white older adults to suffer from Alzheimer’s Disease or other forms of dementia.
The implications of the study extend to policymakers and health professionals, suggesting that addressing early life factors, particularly educational equity, could offer a more effective and equitable approach to mitigating racial disparities in dementia later in life. This finding contrasts with current strategies that often focus on managing midlife and later risk factors like diabetes and hypertension.
The research also highlights implications for primary care clinicians who assess patients’ health metrics to gauge dementia risk. Understanding patients’ childhood backgrounds, including their educational experiences in racially segregated schools, could provide crucial insights for early intervention strategies. For example, a history of attending segregated schools might prompt clinicians to prioritise screening for cognitive impairment.
The study analysed data from the Health and Retirement Study, involving 1,634 non-Hispanic Black and 7,381 non-Hispanic white participants aged 50 and above. It included cognitive function assessments, life history surveys capturing childhood experiences, and genetic cognition-related factors. The findings revealed significant cognitive disparities between Black and white participants, with higher rates of cognitive impairment among Black individuals.
Moreover, the study highlighted that Black participants were more likely to have faced challenging early life experiences, including financial instability, traumatic events, and inadequate educational opportunities. Nearly two-thirds of Black participants attended segregated schools before college, highlighting the enduring impact of racial segregation on academic experiences and subsequent cognitive health.
Advanced statistical methods used in the study determined that early life experiences, particularly attending segregated schools until college, contributed significantly to cognitive disparities and decline among Black individuals. This underscores the systemic nature of educational inequities in shaping mental health outcomes across populations.
In an accompanying editorial in JAMA Internal Medicine, Dr. Reagan W. Durant, the journal’s associate editor for diversity, equity, and inclusion, emphasised the study’s relevance in addressing ongoing racial disparities in education and health outcomes. Despite legal efforts to desegregate schools since the 1954 Brown v. Board of Education decision, economic disparities have perpetuated de facto segregation, influencing educational opportunities and health trajectories.
Durant’s editorial calls for renewed efforts to tackle the historical legacies of segregation that continue to impact health outcomes today. It advocates for equity in education and healthcare to promote cognitive health equity across diverse populations.
More information: Zhuoer Lin et al, Early-Life Circumstances and Racial Disparities in Cognition Among Older Adults in the US, JAMA Internal Medicine. DOI: 10.1001/jamainternmed.2024.1132
Journal information: JAMA Internal Medicine Provided by Yale University
