Association of Racial Residential Segregation Throughout Young Adulthood and Cognitive Performance in Middle-aged Participants in the CARDIA Study
Association of Racial Residential Segregation Throughout Young Adulthood and Cognitive Performance in Middle-aged Participants in the CARDIA Study
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DOI：
10.1001/jamaneurol.2020.0860
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发表时间：
2020-08-01
期刊：
影响因子：
29
通讯作者：
Al Hazzouri, Adina Zeki
中科院分区：
文献类型：
--
作者：
Caunca, Michelle R.;Odden, Michelle C.;Al Hazzouri, Adina Zeki
社区水平的居住隔离被认为是黑人健康状况不佳的决定因素，但目前尚不清楚这种关联是否延伸到认知衰老，特别是在中年。目的探讨黑人青年25年居住隔离的累积暴露与中年认知表现的关系。正在进行的前瞻性队列年轻人冠状动脉风险发展（CARDIA）研究从阿拉巴马大学伯明翰分校的4个实地中心招募了5115名年龄在18至30岁的黑人和白人参与者；明尼苏达大学，明尼阿波利斯；西北大学，芝加哥，伊利诺伊州；以及加州奥克兰的凯撒医疗机构。数据采集时间为1985年2月至2011年5月。在存活的CARDIA队列中，3671人（71.8%）在2010年参加了研究的第25年考试，当时测量了认知能力，其中3008人（81.9%）完成了认知评估。为了考虑时变混杂和微分滤波，应用了使用逆概率加权的边际结构模型。数据分析时间为2019年4月16日至7月20日。使用Getis-Ord G(i)*统计量测量种族居住隔离，并计算从基线到研究第25年的6次随访中平均累积隔离暴露，然后将其分为高、中、低隔离。在研究的第25年，使用数字符号替代测试（DSST）、Stroop颜色测试（反向编码）和Rey听觉语言学习测试来测量认知功能。为了便于估计的比较，计算了所有认知测试的z分数。结果共纳入1568名有认知资料的黑人受试者。在基线时，参与者的平均（SD）年龄为25(4)岁，包括936名女性（59.7%）。相对于隔离程度较低的社区，隔离程度较高的社区的累积暴露与较差的DSST z评分相关（对于高度隔离，beta = -0.37 [95% CI, -0.61至-0.13]；对于中等隔离，beta = -0.25 [95% CI, -0.51至0.0002]）。结论和相关性在这项队列研究中，在整个青年时期暴露于居住隔离与黑人参与者早在中年时的较差处理速度有关。这种关联可能解释了老年痴呆风险中黑人与白人的差异。问题：美国黑人青年时期居住隔离的累积暴露与中年认知表现有关吗？这项对1568名黑人青年冠状动脉风险发展研究的队列研究发现，相对于生活在低隔离社区的黑人青年，生活在高度隔离社区的黑人青年在处理速度上表现得更差。研究结果表明，早在中年时期，长期居住隔离就与黑人的认知能力低下有关，这可能解释了老年痴呆风险中黑人与白人的差异。本队列研究考察了美国黑人在25年的青年时期对居住隔离的累积暴露与中年认知表现之间的关系。
Importance Neighborhood-level residential segregation is implicated as a determinant for poor health outcomes in black individuals, but it is unclear whether this association extends to cognitive aging, especially in midlife. Objective To examine the association between cumulative exposure to residential segregation during 25 years of young adulthood among black individuals and cognitive performance in midlife. Design, Setting, and Participants The ongoing prospective cohort Coronary Artery Risk Development in Young Adults (CARDIA) Study recruited 5115 black and white participants aged 18 to 30 years from 4 field centers at the University of Alabama, Birmingham; University of Minnesota, Minneapolis; Northwestern University, Chicago, Illinois; and Kaiser Permanente, Oakland, California. Data were acquired from February 1985 to May 2011. Among the surviving CARDIA cohort, 3671 (71.8%) attended examination year 25 of the study in 2010, when cognition was measured, and 3008 (81.9%) of those completed the cognitive assessments. To account for time-varying confounding and differential censoring, marginal structural models using inverse probability weighting were applied. Data were analyzed from April 16 to July 20, 2019. Main Outcomes and Measures Racial residential segregation was measured using the Getis-Ord G(i)* statistic, and the mean cumulative exposure to segregation was calculated across 6 follow-up visits from baseline to year 25 of the study, then categorized into high, medium, and low segregation. Cognitive function was measured at year 25 of the study, using the Digit Symbol Substitution Test (DSST), Stroop color test (reverse coded), and Rey Auditory Verbal Learning Test. To facilitate comparison of estimates, z scores were calculated for all cognitive tests. Results A total of 1568 black participants with available cognition data were included in the analysis. At baseline, participants had a mean (SD) age of 25 (4) years and consisted of 936 women (59.7%). Greater cumulative exposure to segregated neighborhoods was associated with a worse DSST z score (for high segregation, beta = -0.37 [95% CI, -0.61 to -0.13]; for medium segregation, beta = -0.25 [95% CI, -0.51 to 0.0002]) relative to exposure to low segregation. Conclusions and Relevance In this cohort study, exposure to residential segregation throughout young adulthood was associated with worse processing speed among black participants as early as in midlife. This association may potentially explain black-white disparities in dementia risk at older age.Question Is cumulative exposure to residential segregation in young adulthood associated with midlife cognitive performance among black individuals in the US? Findings This cohort study of 1568 black participants in the Coronary Artery Risk Development in Young Adults study found that relative to living in low-segregation neighborhoods, black participants who were exposed to highly segregated neighborhoods in young adulthood exhibited worse performance in processing speed. Meaning The findings suggest that cumulative exposure to residential segregation is associated with poor cognitive performance among black individuals as early as midlife, which may explain black-white disparities in dementia risk at older age.This cohort study examines the association between cumulative exposure to residential segregation during 25 years of young adulthood and cognitive performance in midlife among black individuals in the United States.