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Associations of place-based social determinants of health with biomarkers of Alzheimer's disease and related dementias
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Paper Summary
Conflicts of Interest
Identified Weaknesses
Rating Explanation
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Paper Summary
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Black Neighborhoods, Black Brains, Bad News: Systemic Inequality's Toll on Dementia
This study investigated how neighborhood disadvantage, social vulnerability, and environmental injustice (place-based social determinants of health, SDoH) relate to Alzheimer's disease biomarkers. It found that SDoH measures were significantly higher among Black participants compared to White participants. Crucially, these higher SDoH measures were associated with worse neuroimaging biomarkers (like lower cortical thickness and higher cerebral blood flow variability) exclusively among Black participants, not White participants.
Possible Conflicts of Interest
None identified. Authors declared no conflicts of interest related to this work. Funding was received from the American Heart Association and National Institute on Aging.
Identified Weaknesses
Limited Cohort Diversity
The study cohort primarily included Black and White participants, omitting other minoritized groups (Hispanic/Latinx, Asian American, American Indian/Alaska Native) known to be affected by SDoH, which limits the generalizability of findings.
Cross-sectional Design
The data is cross-sectional, meaning it captures a single point in time, preventing conclusions about the causal effects of SDoH on the progression of ADRD over time. Longitudinal studies are needed to understand temporal relationships.
Lack of Residential History Data
The study did not collect data on how long participants lived in a specific residence, making it difficult to ascertain the cumulative impact of long-term exposure to place-based SDoH on ADRD biomarkers.
Exclusion of Cultural Context
The SDoH measures used do not account for the influence of culture, which is recognized as a key social determinant of health and can impact ADRD-associated measures.
Neglect of Social Isolation/Loneliness
The study did not directly assess social isolation or loneliness, which are significant SDoH and known risk factors for cognitive aging and ADRD.
Limitations of Area Deprivation Index (ADI)
The ADI has known limitations, including an overemphasis on median home value and the need for careful standardization, which might affect its accuracy as a composite SDoH measure.
Statistical Robustness After Correction
After rigorous false discovery rate (FDR) correction for multiple comparisons, some initially significant associations did not persist, suggesting that not all initial findings are robust.
Correlation vs. Causation
As an observational study, the identified associations are correlational. While the paper discusses structural racism as a potential upstream cause, the study design itself cannot prove direct causation.
Rating Explanation
The study addresses a critical topic of health disparities in Alzheimer's disease using a robust sample size and multiple biomarkers. However, its cross-sectional design limits causal inference, and the cohort's limited racial/ethnic diversity restricts the generalizability of findings about social determinants of health beyond Black and White participants. Furthermore, some associations were not robust after FDR correction.
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File Information
Original Title:
Associations of place-based social determinants of health with biomarkers of Alzheimer's disease and related dementias
File Name:
paper_2663.pdf
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File Size:
0.84 MB
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October 23, 2025 at 07:19 AM
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