The influence of socioeconomic conditions on the incidence of Alzheimer’s Disease in BWHS - Alzheimer’s Disease and related dementias (ADRD) are important health problems that affect Black Americans more than many other population sub-groups. Socioeconomic conditions associated with housing, education, employment, health care, and other domains – may drive the constellation of social risk factors and comorbidities that increase the risk of ADRD. The mechanisms and pathways by which socioeconomic conditions contribute to ADRD in Black Americans are as yet largely unexplored. We propose to assess the influence of these conditions as they relate to housing, education, and employment on incidence of ADRD in Black women, a group of Americans at high risk of ADRD. Our study will be based on participants and data from a 26-year follow-up study of 59,000 Black women from across the U.S., the Black Women’s Health Study (BWHS). We will develop a measure of socioeconomic conditions that is more comprehensive than most currently in use and test characteristics of this measure against those of several published measures, at the county and state level. Our new measure will use data on factors that include unemployment, poverty, level of education, and housing; the data needed for its development will be obtained by linking participants’ geocoded addresses from 1995-2021 to appropriate public data sources. We will identify incident cases of ADRD through an already developed and tested method of linkage of BWHS participants aged 65 and older to Medicare data for the years 2008-2022; this will yield an estimated 1,500 incident cases of ADRD in 15,000 to 16,000 BWHS participants. Since enrollment in the BWHS in 1995, the participants have provided information on a large number of health and other factors, which include potential risk factors (e.g., hypertension, diabetes, low level of education) and protective factors (e.g., exercise, social support) for ADRD. Thus, it will be possible to assess the effects of socioeconomic conditions alone on incidence of ADRD as well as the combined effects with other common risk factors through moderation or mediation. Since data have been collected over a period of 26 years in geographic areas across the U.S., it will be possible to assess effects of socioeconomic conditions on ADRD incidence over time and place at the county and state level. Thus, the proposed study will provide new and important information on socioeconomic conditions and risk of ADRD in Black women.
