Contribution of Longitudinal Neighborhood Determinants to Cognitive Health and Dementia Disparities within a Multi-Ethnic Cohort

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PROJECT SUMMARY Disasters create widespread disruption across all societal systems. With climate change, the number and intensity of disasters is increasing. Existing research supports a disproportionate impact of disasters among the growing population of older adults. Furthermore, likely heterogeneity in these disaster impacts by individual- and community-level characteristics may exacerbate racial and socioeconomic disparities in health outcomes among this population, such as cognitive decline. This necessitates identification of specific characteristics that influence risk for poor cognitive outcomes related to disaster impact. Neighborhoods offer the opportunity to address disparities by building up community resilience to disaster. Access to supportive neighborhood environments, including places where people come together to interact to build connections, are necessary for coping with disasters. By understanding community changes that mitigate cognitive disparities, we can improve disaster response policies and programs to support institutions that create positive health effects and reduce disparities in cognitive health. This 1-year project will augment a currently funded R01 to identify factors that prevent disaster-related cognitive impairment among older adults. We will integrate quantitative data on disaster exposure from Spatial Hazard Events and Losses Database for the United States (SHELDUS) and community-level resilience from surveys and geographic information systems (GIS) data with individual-level risk factors and health outcomes from the MESA and REGARDS cohorts. To measure and describe climate-related disaster and community resilience over 20 years, we will compute metrics of disaster impact (months, severity) and indicators of access to diverse neighborhood institutions (density, diversity). These data will be linked to the 6,814 MESA participants and 30,107 REGARDS participants (Aim 1). Using longitudinal health data in both cohorts, we will estimate the magnitude of disaster-related cognitive impairment and the community-resilience factors that quantitatively mitigate risk (Aims 2 & 3). We will use the geographic and racial/ethnic diversity of the cohorts to understand individual- and community-disparities in disaster impact and disaster-related cognitive impairment. These findings will result in refined measures of resilience to inform interventions that build disaster resistance and recovery, and ultimately prevent health disparities.