Evaluating the Effect of Neighborhood-level Disadvantage on Brain Health: An Imaging Epidemiology Study

Background The relationship between neighborhood-level socioeconomic disadvantage and brain health is an emerging area of research with critical implications for public health and clinical practice, yet its association with brain structure remains unclear. Purpose To investigate the epidemiologic association between neighborhood-level socioeconomic disadvantage (measured using the Area Deprivation Index [ADI]) and morphometric neuroimaging variables in a real-world clinical population. Materials and Methods This retrospective study, conducted at an academic medical center and associated community partners, used consecutive cross-sectional brain MRI neuroimaging data from patients without radiologic evidence of disease. ADI, a geospatially determined index of neighborhood-level disadvantage, was calculated per patient. Linear regressions was used to test the relationship between ADI and multiple morphometric variables: brain age gap (BAG; estimated minus chronologic brain age), total brain volume (TBV; total gray plus white matter), total white matter hyperintensity volume (WMHV), five subcortical region volumes (hippocampus, thalamus, caudate, putamen, and nucleus accumbens), and four cortical region volumes (anterior cingulate cortex, posterior cingulate cortex, medial frontal cortex, and dorsolateral prefrontal cortex [DLPFC]). Volumetric measures were normalized to intracranial volume. Models controlled for age and sex. Results This study evaluated 2826 patients (mean age, 53 years ± 18.8 [SD]; 1732 female). Residence in the most disadvantaged neighborhoods (national, 116 of 2826 patients; state, 129 of 2826) was associated with higher BAG (adjusted differences, β value, national: 2.72 years [P < .001]; state: 3.02 years [P < .001]) and lower TBV (β value, national: -6.33 normalized mL [P = .01]; state: -7.46 [P = .002]). WMHV was higher among those in the most disadvantaged neighborhoods (β value, national: 0.31 log-transformed normalized mL [P < .001]; state: 0.32 [P < .001]). Interaction models showed increased negative associations between WMHV and striatal (β value, -0.02; P = .01) and DLPFC volumes (β value, -0.40; P = .008) among those in the most disadvantaged neighborhoods. Conclusion Residence in the most disadvantaged neighborhoods was associated with adverse brain morphometry, including higher BAG, lower TBV, and higher WMHV at brain MRI. © RSNA, 2026 Supplemental material is available for this article. See also the editorial by Meltzer in this issue.