Socioeconomically disadvantaged neighborhoods, stroke risk, and cognition in older adults: A focus on violent crime

Living in socioeconomically disadvantaged neighborhoods, i.e., neighborhoods with lower incomes, lower education/occupational levels, and/or higher crime, increases one’s risk of developing chronic health problems, including cardiovascular disease risk factors and stroke. These health problems are associated with reduced cognition and dementia and may help to explain disparities in brain aging. We investigated the association of neighborhood socioeconomic characteristics on stroke risk and cognitive outcomes hypothesizing that stroke risk mediates the association between the socioeconomic environment and cognitive functioning. Participants were non-demented community-dwelling older adults (N=121), ~67 years of age (50% male, 44% non-Latino Black) who underwent cognitive and medical assessments. Stroke risk was measured using the 2017 Framingham Stroke Risk Profile Score (FSRP). Neighborhood socioeconomic characteristics were quantified at either the census tract (income, education, and employment) or the point (violent crime) level. We focused on cognitive domains most vulnerable to pathological aging and stroke risk including memory, attention/information processing, and executive functioning. Structural equation modeling (SEM) evaluated whether FSRP mediated the relationship between neighborhood socioeconomic characteristics and cognitive performance. SEM results accounting for neighborhood income, education, and employment levels revealed that higher rates of violent crime were associated with higher FSRP scores, and higher FSRP scores were associated with reduced attention/information processing performance. Neighborhood-level crime had a significant effect on individual health, which, in turn, impacted individual cognition independent of other socioeconomic neighborhood factors typically investigated. Taken together, results suggest that clinicians working with older adults should query individual and neighborhood health