Abstract
Background
Black and Latino populations have well‐established disparities in dementia, while some studies also find higher rates among American Indian/Alaska Native (AI/AN). Less is known about the distribution of modifiable midlife risk factors across these groups and how these risk factors may predict self‐reported changes in thinking and memory (subjective cognitive decline).
Methods
In the Behavioral Risk Factor Surveillance System (pooled 2015‐2023), we examined the distributions of dichotomized measures of hypertension, diabetes, ever smoking, leisure physical activity, binge drinking, deafness/severe hearing loss, depression, and having a BMI >30 among respondents ages 45‐59 who identified as Black, Latino or AI/AN. Logistic regression models estimated the odds of subjective cognitive decline corresponding with these risk factors overall and stratified by race/ethnicity. All models adjusted for sex and years of education.
Results
We retained complete cases from 4,729 Black, 5,647 Latino and 924 AI/AN participants. Having a BMI>30 was the most prevalent risk factor overall (48%), followed by hypertension (46%) and no leisure physical activity (35%; Table 1). We observed substantial variability in prevalence of risk factors across racial/ethnic groups. The most prevalent risk factor among Black participants was hypertension (54%), among Latino participants was having a BMI<30 (44%) and among AI/AN was being a current/former smoker (56%). In pooled adjusted logistic regression models, all risk factors except binge drinking (OR=1.07 [95% CI = 0.91, 1.26]) predicted higher odds of subjective cognitive decline (Table 2). Poor mental health (pooled OR=5.24 [95% CI=2.67, 5.89]) and deafness/serious hearing loss (pooled OR=3.24 [95% CI=2.68, 3.92]) were the strongest predictors of subjective cognitive decline in both the pooled model and all race/ethnic stratified models. Among Black participants, the next strongest predictor of subjective cognitive decline was hypertension (OR=1.48 [95% CI=1.22, 1.79]). Among Latino participants, diabetes (OR=1.40 [95% CI=1.15, 1.70]) was the next strongest predictor. Among AI/AN participants, current/former smoker was the next strongest predictor (OR=1.69 [95% CI=1.17, 2.43]).
Conclusion
The most relevant risk factors for subjective cognitive decline and promising targets for precision prevention of cognitive impairment are hypertension among Black Americans, diabetes among Latinos and smoking among AI/AN.
