Risk factors for Alzheimer's disease and related dementias in U.S. honor cultures

In recent years, more attention has been given to cultural predictors of Alzheimer's disease and related dementias (ADRD) risk. Yet, research has overlooked the potential risk conferred by U.S. cultures of honor. There is ample reason to suspect that honor-oriented states are at greater risk for ADRD, as many of the characteristics of honor-oriented states are also risk factors for ADRD (e.g., rurality, economic precariousness) and norms within honor cultures (e.g., risk taking, military enlistment, intimate partner violence) may elevate the chance of experiencing neurocognitive ADRD risk factors, like traumatic brain injury (TBI) and subjective cognitive decline (SCD). The present work examined the extent to which statewide honor-orientation predicted estimates of unintentional TBI deaths (2001-2019), SCD (2015-2019), and ADRD deaths (1999-2019) among non-Hispanic Whites. We controlled for period-matched variables known to be associated with honor cultures and ADRD (e.g., rurality, economic precariousness). After controlling for covariates, we observed that more honor-oriented states had higher unintentional TBI death rates (β = 0.39, p = .016), SCD (β = 0.58, p = .001), and ADRD death rates (β = 0.49, p = .030). Findings suggest that the norms and values of honor cultures may confer higher risk for TBI, SCD, and ADRD. Implications for educational, identification, and intervention efforts are discussed.