Neighborhood Racial and Ethnic Segregation and the Risk of Dementia in Older Adults Living with Kidney Failure

Yiting Li; Gayathri Menon; Jane J Long; Yusi Chen; Garyn T Metoyer; Wenbo Wu; Deidra C Crews; Tanjala S Purnell; Roland J Thorpe Jr; Carl V Hill; Sarah L Szanton; Dorry L Segev; Mara A McAdams-DeMarco

doi:10.1681/ASN.0000000000000359

Neighborhood Racial and Ethnic Segregation and the Risk of Dementia in Older Adults Living with Kidney Failure

J Am Soc Nephrol. 2024 Apr 26:(0). doi: 10.1681/ASN.0000000000000359. Online ahead of print.

Authors

Yiting Li¹, Gayathri Menon¹, Jane J Long¹, Yusi Chen¹, Garyn T Metoyer¹, Wenbo Wu^{2

3}, Deidra C Crews⁴, Tanjala S Purnell^{5

6

7}, Roland J Thorpe Jr^{7

8}, Carl V Hill⁹, Sarah L Szanton^{10

11}, Dorry L Segev^{1

3}, Mara A McAdams-DeMarco^{1

3}

Affiliations

¹ Department of Surgery, New York University Grossman School of Medicine, New York, NY.
² Department of Medicine, New York University Grossman School of Medicine, New York, NY.
³ Department of Population Health, New York University Grossman School of Medicine, New York, NY.
⁴ Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.
⁵ Division of Transplantation, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
⁶ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
⁷ Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
⁸ Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
⁹ Diversity, Equity, and Inclusion Officer, Alzheimer's Association.
¹⁰ Johns Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
¹¹ Johns Hopkins University School of Nursing, Baltimore, Maryland.

PMID: 38671538
DOI: 10.1681/ASN.0000000000000359

Abstract

Background: Dementia disproportionately impacts older minoritized adults with kidney failure. To better understand the mechanism of this disparity, we studied the role of racial and ethnic segregation (segregation hereafter), a form of structural racism recently identified as a mechanism in numerous other health disparities.

Methods: We identified 901,065 older adults (age ≥55) with kidney failure from 2003 to 2019 using the United States Renal Data System (USRDS). We quantified dementia risk across tertiles of residential neighborhood segregation score using cause-specific hazard models, adjusting for individual and neighborhood-level factors. We included an interaction term to quantify the differential effect of segregation on dementia diagnosis by race and ethnicity.

Results: We identified 79,851 older adults with kidney failure diagnosed with dementia between 2003 and 2019 (median follow-up: 2.2 years). Compared to those in low-segregation neighborhoods, older adults with kidney failure in high-segregation neighborhoods had a 1.63-fold (95% confidence interval (CI):1.60-1.66) higher risk of dementia diagnosis, an association that differed by race and ethnicity (Asian: adjusted hazard ratio [aHR]=1.26, 95%CI:1.15-1.38; Black: aHR=1.66, 95%CI:1.61-1.71; Hispanic: aHR=2.05, 95%CI:1.93-2.18; White: aHR=1.59, 95%CI:1.55-1.64;Pinteraction<0.001). Notably, older Asian (aHR=1.76, 95%CI:1.64-1.89), Black (aHR=2.65, 95%CI:2.54-2.77), Hispanic (aHR=2.15, 95%CI:2.04-2.26), and White (aHR=2.20, 95%CI:2.09-2.31) adults with kidney failure residing in minority-predominant high-segregation neighborhoods had a higher risk of dementia diagnosis compared to older White adults with kidney failure in White-predominant high-segregation neighborhoods. Moreover, older adults with kidney failure receiving care at dialysis facilities located in high-segregation neighborhoods also experienced a higher risk of dementia diagnosis (aHR=1.53, 95%CI:1.50-1.56); this association differed by race and ethnicity (Pinteraction<0.001).

Conclusions: Residing in or receiving care at dialysis facilities located in high-segregation neighborhoods was associated with a higher risk of dementia diagnosis among older individuals with kidney failure, particularly minoritized individuals.

Abstract

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