Socioeconomic Disparities in Cognitive Impairment: The Role of Neighborhood Social Cohesion

Background and Objectives
Cognitive impairment is a significant public health challenge, particularly as the aging population continues to grow. Individuals from lower socioeconomic backgrounds are at greater risk for cognitive decline, contributing to persistent socioeconomic disparities. While research has predominantly focused on individual-level factors influencing cognitive health, the role of favorable residential environments in mitigating these disparities remains less studied. This study investigates the longitudinal association between time-variant neighborhood social cohesion and cognitive impairments over six years, and its moderating effect on the relationship between socioeconomic status and cognitive impairment, exploring its potential to reduce socioeconomic disparities in cognitive decline.

Research Design and Methods
We analyzed data from the Health and Retirement Study collected in 2012, 2014, 2016, 2018, and 2020. Our sample included respondents aged 50 and older who were not cognitively impaired at baseline, allowing us to identify those who developed cognitive impairment after 2012 (N=11,026).

Results
Multi-level logistic regression models showed that higher levels of perceived neighborhood social cohesion were associated with a lower likelihood of cognitive impairment (OR=0.96, 95% CI=0.95, 0.97, p < .001). Additionally, greater educational attainment and higher family income were associated with lower risks of cognitive impairment. Interaction tests showed that the protective role of neighborhood social cohesion was particularly stronger for individuals from lower socioeconomic backgrounds.

Discussion and Implications
These findings highlight the importance of promoting neighborhood social cohesion as a part of multilevel public health strategies to mitigate cognitive decline and address health disparities in older adults. Further research is warranted to explore the mechanisms underlying these associations and to identify effective approaches for enhancing neighborhood social cohesion in communities with low-socioeconomic individuals, ultimately informing multilevel public health interventions.