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Socioeconomic Status Mediates Racial Differences Seen Using the AT(N) Framework
Karin L Meeker1, Julie K Wisch1, Darrell Hudson2
1Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA.
Annals of Neurology
|October 28, 2020
Summary
African Americans show greater neurodegeneration linked to Alzheimer's disease (AD) dementia. Socioeconomic status (SES) plays a role, highlighting the need for diversity in AD research.
Area of Science:
- Neuroscience
- Public Health
- Medical Imaging
Background:
- African Americans face a higher risk of Alzheimer's disease (AD) dementia compared to non-Hispanic whites.
- Biological, social, and environmental factors contribute to AD dementia risk.
- Understanding racial disparities in AD requires examining neuroimaging biomarkers and socioeconomic factors.
Purpose of the Study:
- To assess neuroimaging biomarkers (amyloid, tau, neurodegeneration) for racial differences in AD.
- To investigate the mediating effects of socioeconomic status (SES) and cardiovascular disease on race-related AD differences.
Main Methods:
- Utilized AT(N) imaging (amyloid and tau PET), MRI, and resting-state functional connectivity (rs-fc) in cognitively normal African American and white participants.
- Included measures of small vessel disease (white matter hyperintensities), cardiovascular health (blood pressure, BMI), and area-based SES.
- Conducted mediation analyses to explore the influence of SES and cardiovascular factors on observed racial differences.
Main Results:
- African American participants exhibited greater neurodegeneration, indicated by decreased cortical volumes, compared to white participants.
- Socioeconomic status (SES) was found to mediate the relationship between race and cortical volumes.
- No significant racial differences were observed for amyloid, tau, or resting-state functional connectivity.
Conclusions:
- Modifiable factors, particularly area-level SES, may explain racial disparities in AD.
- Future AD research should incorporate psychosocial factors and prioritize diversity and inclusion efforts.
- Improving the representativeness of AD studies is crucial for understanding and addressing health inequities.
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