Psychosocial Pathways to Racial/Ethnic Inequalities in Late-Life Memory Trajectories

Abstract

Objectives: Blacks and Hispanics are at increased risk for dementia, even after socioeconomic and vascular factors are taken into account. This study tests a comprehensive model of psychosocial pathways leading to differences in longitudinal cognitive outcomes among older blacks and Hispanics, compared to non-Hispanic whites.

Methods: Using data from 10,173 participants aged 65 and older in the Health and Retirement Study, structural equation models tested associations among race/ethnicity, perceived discrimination, depressive symptoms, external locus of control, and 6-year memory trajectories, controlling for age, sex, educational attainment, income, wealth, and chronic diseases.

Results: Greater perceived discrimination among blacks was associated with lower initial memory level via depressive symptoms and external locus of control, and with faster memory decline directly. Greater depressive symptoms and external locus of control among Hispanics were each independently associated with lower initial memory, but there were no pathways from Hispanic ethnicity to memory decline.

Discussion: Depression and external locus of control partially mediate racial/ethnic differences in memory trajectories. Perceived discrimination is a major driver of these psychosocial pathways for blacks, but not Hispanics. These results can inform the development of policies and interventions to reduce cognitive morbidity among racially/ethnically diverse older adults.

Keywords: Cognition; Depression; Longitudinal Change; Minority and Diverse Populations.

Figure 1.

Schematic of all paths estimated by the structural equation model. For simplicity, covariates (i.e., age, gender, education, income, wealth, chronic disease burden, and stroke) are not shown.

Figure 2.

Significant pathways from black race to memory trajectories, estimated within the same model that included Hispanic ethnicity. Numbers represent standardized regression coefficients. For simplicity, non-significant paths (see Figure 1) and covariates (i.e., age, gender, education, income, wealth, chronic disease burden, stroke) are not shown.

Figure 3.

Significant pathways from Hispanic ethnicity to memory trajectories, estimated within the same model that included black race. Numbers represent standardized regression coefficients. For simplicity, non-significant paths (see Figure 1) and covariates (i.e., age, gender, education, income, wealth, chronic disease burden, stroke) are not shown.