The structural and social determinants of Alzheimer's disease related dementias

Paris B. Adkins-Jackson, Kristen M. George, Lilah M. Besser, Jinshil Hyun, Melissa Lamar, Tanisha G. Hill-Jarrett, Omonigho M. Bubu, Jason D. Flatt, Patricia C. Heyn, Ethan C. Cicero, A. Zarina Kraal, Preeti Pushpalata Zanwar, Rachel Peterson, Boeun Kim, Robert W. Turner, Jaya Viswanathan, Erin R. Kulick, Megan Zuelsdorff, Shana D. Stites, Miguel Arce RenteríaElena Tsoy, Dominika Seblova, Ted K.S. Ng, Jennifer J. Manly, Ganesh Babulal

Research output: Contribution to journalReview articlepeer-review

27 Scopus citations


Introduction: The projected growth of Alzheimer's disease (AD) and AD-related dementia (ADRD) cases by midcentury has expanded the research field and impelled new lines of inquiry into structural and social determinants of health (S/SDOH) as fundamental drivers of disparities in AD/ADRD. Methods: In this review, we employ Bronfenbrenner's ecological systems theory as a framework to posit how S/SDOH impact AD/ADRD risk and outcomes. Results: Bronfenbrenner defined the “macrosystem” as the realm of power (structural) systems that drive S/SDOH and that are the root cause of health disparities. These root causes have been discussed little to date in relation to AD/ADRD, and thus, macrosystem influences, such as racism, classism, sexism, and homophobia, are the emphasis in this paper. Discussion: Under Bronfenbrenner's macrosystem framework, we highlight key quantitative and qualitative studies linking S/SDOH with AD/ADRD, identify scientific gaps in the literature, and propose guidance for future research. Highlights: Ecological systems theory links structural/social determinants to AD/ADRD. Structural/social determinants accrue and interact over the life course to impact AD/ADRD. Macrosystem is made up of societal norms, beliefs, values, and practices (e.g., laws). Most macro-level determinants have been understudied in the AD/ADRD literature.

Original languageEnglish
Pages (from-to)3171-3185
Number of pages15
JournalAlzheimer's and Dementia
Issue number7
StatePublished - Jul 2023


  • ADRD
  • Alzheimer's disease
  • Ecological Systems Theory
  • classism
  • dementia
  • genderism
  • macrosystem
  • racism
  • sexism
  • social determinants of health
  • structural determinants
  • Humans
  • Alzheimer Disease
  • Social Determinants of Health
  • Dementia


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