Neighborhood Disorder and Dementia Risk in U.S. Older Adults: The Role of Cardiometabolic Risk

We estimate the effect of neighborhood disorder on dementia risk among middle-aged and older
adults in the United States and identify cardiometabolic dysregulation as a mediating biological
pathway. Using data from the Health and Retirement Study (HRS, 2006–2020), we show that
exposure to visible neighborhood disorder is associated with higher risk of dementia (Hazard
Ratio: 1.37; 95% CI: 1.08–1.74) and higher risk of cognitive impairment no dementia (CIND;
HR: 1.50; 95% CI: 1.22–1.85) over a 14-year follow-up. Mediation analysis reveals that a
composite cardiometabolic risk score—aggregating seven biomarkers spanning inflammatory,
cardiovascular, and metabolic systems—accounts for approximately 16 percent of the total
neighborhood disorder–dementia association and 19 percent of the neighborhood disorder–CIND
association. These findings are robust to competing-risk regression for mortality, restriction to
non-movers, age-at-onset restrictions, and exclusion of pandemic-year data. The results establish
neighborhood disorder as a modifiable upstream risk factor for cognitive decline and identify
cardiometabolic health as a biologically proximate mediating pathway. The findings have
implications for place-based public health policy: community-level interventions that
simultaneously reduce visible signs of neighborhood decay and address cardiometabolic risk
may yield dementia-prevention dividends beyond what individual-level clinical strategies alone
can achieve.