Stroke Belt birth state and late-life cognition in the Study of Healthy Aging in African Americans (STAR)

Kristen M. George, Rachel L. Peterson, Paola Gilsanz, Lisa L. Barnes, Elizabeth Rose Mayeda, M. Maria Glymour, Dan M. Mungas, Charles S. DeCarli, Rachel A. Whitmer

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Purpose: We examined the association of Stroke Belt birth state with late-life cognition in The Study of Healthy Aging in African Americans (STAR). Methods: STAR enrolled 764 Black Americans ages 50+ who were long-term Kaiser Permanente Northern California members. Participants completed Multiphasic Health Check-ups (MHC; 1964–1985) where early-life overweight/obesity, hypertension, diabetes, and hyperlipidemia were measured. At STAR (2018), birth state, self-reported early-life socioeconomic status (SES), and executive function, verbal episodic memory, and semantic memory scores were collected. We used linear regression to examine the association between Stroke Belt birth and late-life cognition adjusting for birth year, gender, and parental education. We evaluated early-life SES and cardiovascular risk factors (CVRF) as potential mechanisms. Results: Twenty-seven percent of participants were born in the Stroke Belt with a mean age of 69 (standard deviation = 9) at STAR. Stroke Belt birth was associated with worse late-life executive function (β [95% confidence interval]: −0.18 [−0.33, −0.02]) and semantic memory (−0.37 [−0.53, −0.21]), but not verbal episodic memory (−0.04 [−0.20, 0.12]). Adjustment for SES and CVRF attenuated associations of Stroke Belt birth with cognition (executive function [−0.05 {−0.25, 0.14}]; semantic memory [−0.28 {−0.49, −0.07}]). Conclusions: Black Americans born in the Stroke Belt had worse late-life cognition than those born elsewhere, underscoring the importance of early-life exposures on brain health.

Original languageEnglish
Pages (from-to)26-32
Number of pages7
JournalAnnals of Epidemiology
StatePublished - Dec 2021


  • Alzheimer disease
  • Cardiovascular diseases
  • Cerebrovascular disease
  • Cognitive dysfunction
  • Dementia
  • Health status disparities
  • Heart disease risk factors
  • Minority health
  • Social determinants of health
  • Socioeconomic status


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