Racial Disparities in Cognitive Outcomes Linked to Early Life Experiences

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May 29, 2024 Story by: Editor

A recent cross-sectional study found that early life experiences significantly impact cognitive outcomes for Black and White individuals over 50, revealing stark racial disparities.

The study, led by Xi Chen, PhD, of the Yale School of Public Health , showed that Black participants had lower cognitive scores (13.5 points) compared to their White counterparts (15.8 points) on a 27-point scale. Additionally, cognitive impairment—defined as a score below 12—was more prevalent among Black participants (33.6%) than White participants (16.4%).

Chen and his team reported in JAMA Internal Medicine that differences in early life circumstances, including educational experiences, accounted for 61.5% of the racial disparities in cognitive scores and 82.3% in cognitive impairment. Specifically, educational experiences contributed to 35.2% of disparities in cognitive scores and 48.6% in cognitive impairment. School racial segregation (all segregated schooling before college) was linked to 28.8% of disparities in cognitive scores and 39.7% in cognitive impairment.

"School segregation really stands out to be the most important one, more so than the measure of the years of education," Chen told MedPage Today.

Previous studies have shown that dementia is nearly twice as common among Black adults compared to Whites, even after adjusting for age, sex, and some educational factors. While mid- to late-life factors have been associated with cognitive outcomes, early life education has been less studied.

The study underscores the need to look beyond quantitative measures of educational attainment, noted Raegan Durant, MD, MPH, of the University of Alabama at Birmingham, in an accompanying editorial . Durant highlighted that Black students in desegregated schools likely faced direct stress from interpersonal and institutional racism, while some Black students in segregated schools thrived academically.

"To better understand the lifelong health effects of school segregation, we must also identify and explore the mechanisms of resilience driving those Black individuals who achieved academically despite social determinants that were often systematically aligned against them," Durant wrote.

Chen and co-authors utilized data from the Health and Retirement Study (HRS) , a large, nationally representative study of adults over 50. They analyzed self-reported early life circumstances from three HRS components: the core survey, the Life History Mail Survey, and the Enhanced Face-to-Face Interview.

The study included 9,015 participants (18.1% Black and 81.9% White). Among Black participants, the mean age was 69.2, with 67.0% being women. Among White participants, the mean age was 73.2, with 59.7% being women.

Cognitive scores were assessed using tests adapted from the Telephone Interview for Cognitive Status (TICS), including immediate word recall, delayed word recall, serial 7s subtraction, and backward counting. Scores ranged from 0-27 points, with scores below 12 indicating cognitive impairment.

Researchers evaluated traditional early-life circumstances in one model, considering factors like age cohort, regional and financial conditions, health, trauma, family relationships, and years of educational attainment. A second model included early life educational experiences, such as family education, owning books, preschool attendance, and school segregation.

"The findings of this cross-sectional study suggest that less favorable early-life circumstances are associated with clinically meaningful racial disparities in late-life cognition," Chen and co-authors wrote. "Policies that improve educational equity have the potential to reduce racial disparities in cognition in older ages." Source: MedPage Today

The study acknowledged limitations, including potential bias due to non-participation of individuals with impaired cognition or other health issues, small sample sizes preventing the study of other racial and ethnic groups, and the inability to evaluate dementia as an outcome due to its low prevalence. Additionally, variations in the quality of segregated schools and other unknown early life factors were not accounted for.