Question Is school racial segregation during childhood associated with cognitive outcomes in later life among non-Hispanic Black and non-Hispanic White US residents?
Findings In this cross-sectional study of a nationally representative sample of 21 121 persons, Black individuals exposed to high levels of school segregation had lower cognitive scores and a higher likelihood of cognitive impairment and dementia in later life than those with low exposure. These findings were significant after accounting for a comprehensive array of covariates and life-course mediators; no associations were found among White individuals.
Meaning These findings suggest that strengthened efforts to reduce school racial segregation could have lasting benefits for cognitive health and advance racial equity, particularly given the enduring segregation of schools as a prominent form of structural racism in the US.
Importance Disparities in cognition, including dementia occurrence, persist between non-Hispanic Black (hereinafter, Black) and non-Hispanic White (hereinafter, White) older adults, and are possibly influenced by early educational differences stemming from structural racism. However, the association between school racial segregation and later-life cognition remains underexplored.
Objective To investigate the association between childhood contextual exposure to school racial segregation and cognitive outcomes in later life.
Design, Setting, and Participants This cross-sectional study examined a nationally representative sample of US older adults from the Health and Retirement Study. Both restricted childhood residence data and publicly available cognitive assessment data (survey years 1995-2018) were used for Black and White participants aged 65 years and older. Data analyses were performed from March 2, 2023, to October 22, 2024.
Exposures State-level Black and White dissimilarity index for public elementary schools in the late 1960s (range, 0-100) was used to measure school segregation. States were categorized into high segregation (≥83.6) and low segregation (<83.6) based on the top quintile.
Main Outcomes and Measures Cognitive scores, cognitive impairment, and dementia were assessed using the Telephone Interview for Cognitive Status and proxy assessment. Multilevel regression analyses were conducted stratified by race and ethnicity, adjusting for sociodemographic covariates. Potential early-life and midlife mediators, including educational attainment, were assessed.
Results The study sample included 3566 Black (16 104 observations) and 17 555 White (90 874 observations) participants. The mean (SD) age of the sample was 75.6 (7.5) years, and 62 187 (58.1%) were female. Participants exposed to high vs low segregation exhibited lower cognitive scores (13.6 vs 14.5) and a higher prevalence of cognitive impairment (37.0% vs 28.0%) and dementia (14.1% vs 9.3%). Multilevel analyses revealed a significant negative association between school segregation and later-life cognitive outcomes among Black participants, but not among White participants, after adjusting for covariates. Potential mediators across the life course, including educational attainment, explained 57.6% to 72.6% of the association, yet the findings were significant among Black participants for all outcomes. In the model including all mediators and covariates, Black participants exposed to high segregation exhibited significantly lower cognitive scores (coefficient, −0.26; 95% CI, −0.43 to −0.09) and a higher likelihood of cognitive impairment (adjusted odds ratio [AOR], 1.35; 95% CI, 1.12-1.63) and dementia (AOR, 1.26; 95% CI, 1.03-1.54).
Conclusions and Relevance This cross-sectional study of Black and White older individuals found that childhood exposure to school segregation was associated with late-life cognition among the Black population. Given the increasing amount of school segregation in the US, educational policies aimed at reducing segregation are needed to address health inequities. Clinicians may leverage patients’ early-life educational circumstances to promote screening, prevention, and management of cognitive disorders.
Cognitive impairment poses considerable challenges for older adults,1 with Alzheimer disease and related dementias affecting millions of US residents and the burden escalating as the population ages. Marked racial and ethnic disparities persist.2 Cognitive disorders disproportionally impact disadvantaged populations, diminishing individual well-being and imposing substantial burdens on caregivers and families, thereby exacerbating societal racial and ethnic disparities.3
Emerging evidence underscores the profound influence of adverse early-life circumstances on brain development and cognitive decline over the lifespan.4-6 Racial differences in early educational environments, particularly those rooted in structural racism, appear to be pivotal in shaping cognition in later life.7-9
School racial segregation (hereinafter, school segregation), a major aspect of US education systems, may exert particularly profound effects on cognition.10 This practice physically segregates students in educational institutions based on racial backgrounds, resulting in vastly unequal educational experiences, qualities, and opportunities between White and minoritized populations. Despite the historic Brown v Board of Education ruling, US schools continue to struggle with heightened levels of segregation,11,12 with more than half of students attending schools in districts that have predominantly White or racial and ethnic minority group populations, and approximately 40% of Black students attending schools with populations that are 90% to 100% racial and ethnic minority groups.13,14
No comments:
Post a Comment