Evaluating segregated school attendance as a mediator of geographic inequities in late-life cognitive function: evidence from the Study of Healthy Aging in African Americans (STAR)

INTRODUCTION: Birth in the Southern United States is associated with poorer late-life cognitive health, especially among Black Americans, yet the role of school segregation is unclear. METHODS: Utilizing decomposition methods, we estimated the total effect, natural direct effect (NDE), and natural indirect effect (NIE) of Southern birth on domain-specific cognition among 727 older Black adults, adjusting for early-life covariates. We also estimated the proportion of the total effect mediated by self-reported segregated school attendance. RESULTS: Southern birth was associated with lower late-life executive function and semantic memory; estimates were negative but not significant for verbal episodic memory. The direct effect of Southern birth was negative but not significant for all domains. Attending a segregated school mediated 35% and 49% of the total association between Southern birth and executive function (NIE: −0.07, 95% confidence interval [CI]: [−0.18, 0.02]) and semantic memory (NIE:−0.17, 95% CI: [−0.29, −0.06]). DISCUSSION: School segregation may partially drive geographic inequities in late-life cognition in the United States. Highlights: Southern birth has been linked to poorer cognitive health in later life. Segregated schooling may partially explain geographic disparities in brain aging. Black adults born in the South had lower cognitive function and were more likely to attend segregated schools. Segregated schooling accounted for 35% to 49% of the association between Southern birth and cognition.