Education Can Narrow Racial Disparities in Alzheimer’s
In the US, older black adults face almost twice the risk of Alzheimer’s dementia as their white counterparts. Now, a new study led by a School of Public Health researcher confirms this gap and suggests it is due to disparities in education.
The study, published in Epidemiology, found similar rates of cognitive decline in black and white participants, but black participants scored substantially lower on average in the study’s cognitive tests than white participants of the same age; the performance gap was equivalent to the performance gap between participants 12 years apart in age. When the researchers modeled a scenario where all participants had had 16 years of formal education, the racial disparity in cognitive function fell by more than 50 percent, and the disparity in Alzheimer’s risk fell by nearly 40 percent.
“One of the strongest determinants of cognitive level is educational attainment,” says lead author Jennifer Weuve, associate professor of epidemiology. The researchers found black participants had completed an average of two fewer years of formal education than white participants.
“Education, unlike race, is modifiable,” Weuve says.
Weuve also notes the metric of years of education does not provide insight into quality of education, which she says is especially important to consider because many of the participants were schoolchildren before Brown v. Board of Education, and educated in the era of “separate but unequal” schools. “It’s possible, then, that we underestimated the power that education has on diminishing the racial disparity in dementia,” Weuve says.
The study used the cohort from the Chicago Health and Aging Project (CHAP), which has followed a total of 10,802 individuals 65 years old or older living on the south side of Chicago since 1993. Participants were interviewed and their cognitive function tested in three-year cycles, and a sample also underwent clinical evaluation for Alzheimer’s dementia. A total of 441 participants have developed Alzheimer’s, with an “extra” 58 cases per 1,000 every three years among black participants compared to their white counterparts, the authors wrote.
Based on self-identification, the CHAP cohort is 60 percent black and 40 percent white. “Our study included more black participants—often by an order of magnitude—than any previous comparisons of cognitive decline and dementia risk in blacks and whites,” the authors wrote.
Because education is influenced by social policy, the authors said, improving access and reducing inequities in education could be a potent strategy to reduce Alzheimer’s dementia risk at the population level, as well as reduce racial disparities in cognitive well-being.
“The era of governmentally sanctioned segregation is behind us,” Weuve says, “but racial disparities in educational attainment and quality persist to this day.”
Other authors were: Lisa Barnes, professor of neurological sciences and behavioral sciences at Rush University Medical Center; Carlos Mendes de Leon, professor of epidemiology at the University of Michigan School of Public Health; Kumar B. Rajan, associate professor in the Department of Internal Medicine at Rush Medical College; Todd Beck, senior statistical analyst at Rush Bioinformatics and Biostatistics Core; Neelum Aggarwal, associate professor in the Department of Neurological Sciences at Rush Medical Center; Liesi Hebert, assistant professor at Rush University Medical Center; David Bennett, director of the Rush Alzheimer’s Disease Center and the Robert C. Borwell Professor of Neurological Sciences at Rush Medical College; Robert Wilson, professor in the Department of Neurological Sciences at Rush Medical College; and Denis Evans, director of the Rush Institute for Healthy Aging.