Ethnoracial disparities in cognition are associated with multiple socioeconomic status-stress pathways

Abstract

Systemic racism can have broad impacts on health in ethnoracial minorities. One way is by suppressing socioeconomic status (SES) levels through barriers to achieve higher income, wealth, and educational attainment. Additionally, the weathering hypothesis proposes that the various stressful adversities faced by ethnoracial minorities lead to greater wear and tear on the body, known as allostatic load. In the present study, we extend these ideas to cognitive health in a tri-ethnic sample of young adults-when cognition and brain health is arguably at their peak. Specifically, we tested competing mediation models that might shed light on how two key factors caused by systemic racism-SES and perceived stress-intersect to explain ethnoracial disparities in cognition. We found evidence for partial mediation via a pathway from SES to stress on episodic memory, working memory capacity, and executive function in Black Americans relative to non-Hispanic White Americans. Additionally, we found that stress partially mediated the ethnoracial disparities in working memory updating for lower SES Black and Hispanic Americans relative to non-Hispanic White Americans, showing that higher SES can sometimes reduce the negative effects stress has on these disparities in some cognitive domains. Overall, these findings suggest that multiple pathways exist in which lower SES creates a stressful environment to impact ethnoracial disparities cognition. These pathways differ depending on the specific ethnoracial category and cognitive domain. The present results may offer insight into strategies to help mitigate the late-life risk for neurocognitive disorders in ethnoracial minorities.

Keywords: Cognition; Health disparities; Perceived stress; Socioeconomic status; Weathering hypothesis.

Fig. 1

Raincloud plots are presented illustrating ethnoracial category differences in perceived stress (left) and socioeconomic status (right) for Non-Hispanic White Americans (red), Black American (green), and Hispanic Americans (blue)

Fig. 2

Raincloud plots are presented illustrating ethnoracial category differences in cognition for Non-Hispanic White Americans (red), Black American (green), and Hispanic Americans (blue). The asterisks denote which cognitive tasks also were associated with perceived stress and included in the subsequent mediation analyses. Note that the Penn Word Test did not differ by ethnoracial category, likely due to ceiling effects and so is not included. For completeness, no outliers were removed for these comparisons

Fig. 3

Parallel mediation analyses for picture sequencing (A), list sorting (B), card sorting (C), and the N-Back (D). Perceived stress predicted ethnoracial disparities in cognition for the picture sequence task and the list sorting task, but not the other two. SES predicted ethnoracial disparities in cognition for all four cognitive tasks. Unstandardized parameter estimates and standard errors are shown for each pathway. Asterisks denote significant pathways for one ethnoracial minority with a single line and for both ethnoracial minorities with a double line: * = p < .05, ** = p < .01, *** = p < .001. Dashed lines represent non-significant pathways. Red lines and text represent significant mediating pathways

Fig. 4

Sequential mediation analyses for picture sequencing (A), list sorting (B), card sorting (C), and the N-back (D). Socioeconomic status (SES) predicted perceived stress, which in turn predicted ethnoracial disparities in cognition for the picture sequence task and the working memory task, but not the other two. An independent SES predicted ethnoracial disparities in cognition for all four cognitive tasks. Unstandardized parameter estimates and standard errors are shown for each pathway. Asterisks denote significant pathways for one ethnoracial minority with a single line and for both ethnoracial minorities with a double line: * = p < .05, ** = p < .01, *** = p < .001. Dashed lines represent non-significant pathways. Red lines and text represent significant mediating pathways

Fig. 5

Moderated mediation analyses for picture sequencing (A), list sorting (B), card sorting (C), and the N-back (D). Socioeconomic status (SES) moderated the effect of perceived stress on ethnoracial disparities in cognition only for card sorting and the N-back task. Unstandardized parameter estimates and standard errors are shown for each pathway. Asterisks denote significant pathways for one ethnoracial minority with a single line and for both ethnoracial minorities with a double line: * = p < .05, ** = p < .01, *** = p < .001. Dashed lines represent non-significant pathways. Red lines and text represent significant mediating pathways