The structural and social determinants of Alzheimer's disease related dementias

Author:

Adkins‐Jackson Paris B.1ORCID,George Kristen M.2,Besser Lilah M.3,Hyun Jinshil4,Lamar Melissa5,Hill‐Jarrett Tanisha G.6,Bubu Omonigho M.7,Flatt Jason D.8,Heyn Patricia C.9,Cicero Ethan C.10,Zarina Kraal A.11,Pushpalata Zanwar Preeti1213,Peterson Rachel14,Kim Boeun15,Turner Robert W.16,Viswanathan Jaya17,Kulick Erin R.18,Zuelsdorff Megan19,Stites Shana D.20,Arce Rentería Miguel21,Tsoy Elena22,Seblova Dominika23,Ng Ted K.S.2425,Manly Jennifer J.11,Babulal Ganesh26272829

Affiliation:

1. Departments of Epidemiology & Sociomedical Sciences Mailman School of Public Health Columbia University New York New York USA

2. Department of Public Health Sciences University of California Davis School of Medicine Davis California USA

3. Comprehensive Center for Brain Health University of Miami Miller School of Medicine Miami Florida USA

4. The Saul R. Korey Department of Neurology Albert Einstein College of Medicine Bronx New York New York USA

5. Rush Alzheimer's Disease Center and the Department of Psychiatry and Behavioral Sciences Rush University Medical Center Chicago Illinois USA

6. Department of Neurology Memory and Aging Center University of California San Francisco California USA

7. Departments of Psychiatry Population Health & Neurology New York University Grossman School of Medicine New York New York USA

8. Department of Social and Behavioral Health School of Public Health University of Nevada Las Vegas Nevada USA

9. Center for Optimal Aging Marymount University Arlington Virginia USA

10. Nell Hodgson Woodruff School of Nursing Emory University Atlanta Georgia USA

11. Department of Neurology Columbia University New York New York USA

12. Applied Health Economics & Outcomes Research & Health Policy Jefferson College of Population Health Thomas Jefferson University Philadelphia Pennsylvania USA

13. NIA Funded Network on Life Course and Health Dynamics and Disparities University of Southern California Los Angeles California USA

14. School of Public and Community Health Sciences University of Montana Missoula Montana USA

15. School of Nursing Johns Hopkins University Baltimore Maryland USA

16. Clinical Research & Leadership Neurology The George Washington University Washington, D.C. USA

17. Bethesda Maryland USA

18. MPH Department of Epidemiology and Biostatistics Temple University Philadelphia Pennsylvania USA

19. School of Nursing Alzheimer's Disease Research Center, and School of Medicine and Public Health University of Wisconsin‐Madison Madison Wisconsin USA

20. MA Department of Psychiatry Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA

21. Department of Neurology Taub Institute for Research on Alzheimer's Disease and the Aging Brain Columbia University Medical Center New York New York USA

22. Department of Neurology Memory and Aging Center University of California San Francisco Global Brain Health Institute University of California San Francisco and Trinity College Dublin San Francisco California USA

23. Second Faculty of Medicine Charles University Prague Czech Republic

24. Edson College of Nursing and Health Innovation Arizona State University Phoenix Arizona USA

25. Center for Innovation in Healthy and Resilient Aging Arizona State University Phoenix Arizona USA

26. Department of Neurology Washington University School of Medicine St. Louis Missouri USA

27. Institute of Public Health Washington University in St. Louis St. Louis Missouri USA

28. Department of Clinical Research and Leadership School of Medicine and Health Sciences, The George Washington University Washington, D.C. USA

29. Department of Psychology Faculty of Humanities University of Johannesburg South Africa

Abstract

AbstractIntroductionThe projected growth of Alzheimer's disease (AD) and AD‐related dementia (ADRD) cases by midcentury has expanded the research field and impelled new lines of inquiry into structural and social determinants of health (S/SDOH) as fundamental drivers of disparities in AD/ADRD.MethodsIn this review, we employ Bronfenbrenner's ecological systems theory as a framework to posit how S/SDOH impact AD/ADRD risk and outcomes.ResultsBronfenbrenner defined the “macrosystem” as the realm of power (structural) systems that drive S/SDOH and that are the root cause of health disparities. These root causes have been discussed little to date in relation to AD/ADRD, and thus, macrosystem influences, such as racism, classism, sexism, and homophobia, are the emphasis in this paper.DiscussionUnder Bronfenbrenner's macrosystem framework, we highlight key quantitative and qualitative studies linking S/SDOH with AD/ADRD, identify scientific gaps in the literature, and propose guidance for future research.Highlights Ecological systems theory links structural/social determinants to AD/ADRD. Structural/social determinants accrue and interact over the life course to impact AD/ADRD. Macrosystem is made up of societal norms, beliefs, values, and practices (e.g., laws). Most macro‐level determinants have been understudied in the AD/ADRD literature.

Publisher

Wiley

Subject

Psychiatry and Mental health,Cellular and Molecular Neuroscience,Geriatrics and Gerontology,Neurology (clinical),Developmental Neuroscience,Health Policy,Epidemiology

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