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 Rentería; Elena Tsoy; Dominika Seblova; Ted K.S. Ng; Jennifer J. Manly; Ganesh Babulal

doi:10.1002/alz.13027

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

School of Public and Community Health Sciences

Research output: Contribution to journal › Review article › peer-review

136 Scopus citations

Abstract

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 language	English
Pages (from-to)	3171-3185
Number of pages	15
Journal	Alzheimer's and Dementia
Volume	19
Issue number	7
DOIs	https://doi.org/10.1002/alz.13027
State	Published - Jul 2023

Funding

We would like to thank the entire Alzheimer's Association ISTAART Diversity and Disparities Professional Interest Area (PIA) Structural and SDOH Workgroup for their support. This work was supported by the Columbia University Alzheimer's Disease Resource Centers for Minority Aging Research (RCMAR) [P30AG059303, 2018–2023 (Manly), 2019–2020 pilot (Bubu), 2019–2021 pilot (Arce Rentería), 2022–2023 pilot (Adkins‐Jackson) (Kraal)]; NIA [R01AG052132, 2021–2026 (Whitmer, Glymour, Gilsanz, Mayeda), 2022–2027 (Whitmer, Gilsanz, Corrada)], [RF1AG050782, 2017–2022 (Whitmer)], [K01AG063895, 2020–2025 (Besser)], [R21AG075291, 2022–2024 (Besser)], [K23AG068534, 2021–2026 (Bubu)], [L30‐AG064670, 2019–2023 (Bubu)], [3K01AG054762‐03S1, 2022–2023 (Turner)], [3K01AG054762, 2022–2023 (Turner)], [K01AG056669, 2022–2023 (Flatt)], [R24AG065170, 2022–2023 (Flatt)], [5TR13AG072884‐02 (Heyn PC)], [1R13AG071313‐01, 2021–2024 (Turner, Rivera‐Mindt)], [(K23AG065442, 2020–2024 (Stites)], [R03AG063303, 2019–2022 (Zuelsdorff)], [R01AG062711 (Lamar)], [DP1AG069874, 2020–2024 (Kim)], [1K99AG066932, 2020–2022 (Arce Rentería)], 3K23AG065442‐03S1, 2022–2023 (Stites)], [U24AG058556, 2020–2023 (Stites)], [R01AG074302, 2021–2026 (Babulal)], [R01AG068183, 2020–2025 (Babulal), [R01AG067428, 2020–2025 (Babulal)], [R01AG056466, 2017–2023 (Babulal)]; National Institute of Neurological Disorders and Stroke (NINDS) [R01NS119651, 2022–2023 subward (Turner II)]; California Department of Public Health [RFA 20‐10079, 2022–2024 (Nosheny, Mayeda, George)]; Krueger v. Wyeth Inc. Class Action [2021–2026 (Whitemer)]; New York University Alzheimer's Disease Research Center Developmental Pilot [P30AG066512, 2020–2022 (Bubu)]; BrightFocus Foundation [A2022033S, 2022–2025 (Bubu)], [A2021142S, 2020–2023 (Babulal)]; Harmony Biosciences [Progress at the Heart Program, 2021–2023 subaward (Turner)]; Arizona State University, Center for Innovation in Healthy and Resilient Aging [PG‐14829, pilot (Ng)]; PRIMUS Research Programme [22/MED/012, 2022–2025 (Seblova)]; Alzheimer's Association [AARG‐21‐850963, 2022–2025 (Besser)], [AARG‐D‐21‐848397, 2021–2023 (Bubu)], [AARFD‐22‐924846, 2022–2025 (Kraal)], Alzheimer's Association [Emerging Scholars Program, 2021–2024 (Turner, Rivera‐Mindt)], [AARF‐18‐562958, 2018–2022 (Zuelsdorff)], [AARF‐17‐528934, 2017–2023 (Stites)], [AARFD‐18‐565015, 2018–2022 (Arce Rentería)], [AARF‐21‐851552, 2021–2023 (Tsoy)], [AARF‐21‐848200, 2022–2025 (Seblova)]. We would like to thank the entire Alzheimer's Association ISTAART Diversity and Disparities Professional Interest Area (PIA) Structural and SDOH Workgroup for their support. This work was supported by the Columbia University Alzheimer's Disease Resource Centers for Minority Aging Research (RCMAR) [P30AG059303, 2018–2023 (Manly), 2019–2020 pilot (Bubu), 2019–2021 pilot (Arce Rentería), 2022–2023 pilot (Adkins-Jackson) (Kraal)]; NIA [R01AG052132, 2021–2026 (Whitmer, Glymour, Gilsanz, Mayeda), 2022–2027 (Whitmer, Gilsanz, Corrada)], [RF1AG050782, 2017–2022 (Whitmer)], [K01AG063895, 2020–2025 (Besser)], [R21AG075291, 2022–2024 (Besser)], [K23AG068534, 2021–2026 (Bubu)], [L30-AG064670, 2019–2023 (Bubu)], [3K01AG054762-03S1, 2022–2023 (Turner)], [3K01AG054762, 2022–2023 (Turner)], [K01AG056669, 2022–2023 (Flatt)], [R24AG065170, 2022–2023 (Flatt)], [5TR13AG072884-02 (Heyn PC)], [1R13AG071313-01, 2021–2024 (Turner, Rivera-Mindt)], [(K23AG065442, 2020–2024 (Stites)], [R03AG063303, 2019–2022 (Zuelsdorff)], [R01AG062711 (Lamar)], [DP1AG069874, 2020–2024 (Kim)], [1K99AG066932, 2020–2022 (Arce Rentería)], 3K23AG065442-03S1, 2022–2023 (Stites)], [U24AG058556, 2020–2023 (Stites)], [R01AG074302, 2021–2026 (Babulal)], [R01AG068183, 2020–2025 (Babulal), [R01AG067428, 2020–2025 (Babulal)], [R01AG056466, 2017–2023 (Babulal)]; National Institute of Neurological Disorders and Stroke (NINDS) [R01NS119651, 2022–2023 subward (Turner II)]; California Department of Public Health [RFA 20-10079, 2022–2024 (Nosheny, Mayeda, George)]; Krueger v. Wyeth Inc. Class Action [2021–2026 (Whitemer)]; New York University Alzheimer's Disease Research Center Developmental Pilot [P30AG066512, 2020–2022 (Bubu)]; BrightFocus Foundation [A2022033S, 2022–2025 (Bubu)], [A2021142S, 2020–2023 (Babulal)]; Harmony Biosciences [Progress at the Heart Program, 2021–2023 subaward (Turner)]; Arizona State University, Center for Innovation in Healthy and Resilient Aging [PG-14829, pilot (Ng)]; PRIMUS Research Programme [22/MED/012, 2022–2025 (Seblova)]; Alzheimer's Association [AARG-21-850963, 2022–2025 (Besser)], [AARG-D-21-848397, 2021–2023 (Bubu)], [AARFD-22-924846, 2022–2025 (Kraal)], Alzheimer's Association [Emerging Scholars Program, 2021–2024 (Turner, Rivera-Mindt)], [AARF-18-562958, 2018–2022 (Zuelsdorff)], [AARF-17-528934, 2017–2023 (Stites)], [AARFD-18-565015, 2018–2022 (Arce Rentería)], [AARF-21-851552, 2021–2023 (Tsoy)], [AARF-21-848200, 2022–2025 (Seblova)].

Funders	Funder number
P30AG059303
DP1AG069874, U24AG058556, R01AG067428, K01AG063895, K01AG056669, RF1AG050782, 5TR13AG072884‐02, K23AG068534, R03AG063303, R01AG052132, K23AG065442, R01AG056466, R01AG074302, 1K99AG066932, L30-AG064670, R01AG068183, R21AG075291, R24AG065170, 3K01AG054762, R01AG062711, 1R13AG071313‐01
R01NS119651
RFA 20‐10079
A2021142S, A2022033S
P30AG066512
Arizona State University	22/MED/012, AARF-17-528934, AARFD-18-565015, AARFD-22-924846, AARF-21-848200, AARF-18-562958, AARG-21-850963, AARG-D-21-848397, PG-14829, AARF-21-851552

Keywords

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

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1002/alz.13027

Cite this

Adkins-Jackson, P. B., George, K. M., Besser, L. M., Hyun, J., Lamar, M., Hill-Jarrett, T. G., Bubu, O. M., Flatt, J. D., Heyn, P. C., Cicero, E. C., Zarina Kraal, A., Pushpalata Zanwar, P., Peterson, R., Kim, B., Turner, R. W., Viswanathan, J., Kulick, E. R., Zuelsdorff, M., Stites, S. D., ... Babulal, G. (2023). The structural and social determinants of Alzheimer's disease related dementias. Alzheimer's and Dementia, 19(7), 3171-3185. https://doi.org/10.1002/alz.13027

@article{57470ead849140fd85f0c1bc72eb807e,

title = "The structural and social determinants of Alzheimer's disease related dementias",

abstract = "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.",

keywords = "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",

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

note = "{\textcopyright} 2023 The Authors. Alzheimer's \& Dementia published by Wiley Periodicals LLC on behalf of Alzheimer's Association.",

year = "2023",

month = jul,

doi = "10.1002/alz.13027",

language = "English",

volume = "19",

pages = "3171--3185",

journal = "Alzheimer's and Dementia",

issn = "1552-5260",

publisher = "John Wiley and Sons Inc.",

number = "7",

}

Adkins-Jackson, PB, George, KM, Besser, LM, Hyun, J, Lamar, M, Hill-Jarrett, TG, Bubu, OM, Flatt, JD, Heyn, PC, Cicero, EC, Zarina Kraal, A, Pushpalata Zanwar, P, Peterson, R, Kim, B, Turner, RW, Viswanathan, J, Kulick, ER, Zuelsdorff, M, Stites, SD, Arce Rentería, M, Tsoy, E, Seblova, D, Ng, TKS, Manly, JJ & Babulal, G 2023, 'The structural and social determinants of Alzheimer's disease related dementias', Alzheimer's and Dementia, vol. 19, no. 7, pp. 3171-3185. https://doi.org/10.1002/alz.13027

TY - JOUR

T1 - The structural and social determinants of Alzheimer's disease related dementias

AU - Adkins-Jackson, Paris B.

AU - George, Kristen M.

AU - Besser, Lilah M.

AU - Hyun, Jinshil

AU - Lamar, Melissa

AU - Hill-Jarrett, Tanisha G.

AU - Bubu, Omonigho M.

AU - Flatt, Jason D.

AU - Heyn, Patricia C.

AU - Cicero, Ethan C.

AU - Zarina Kraal, A.

AU - Pushpalata Zanwar, Preeti

AU - Peterson, Rachel

AU - Kim, Boeun

AU - Turner, Robert W.

AU - Viswanathan, Jaya

AU - Kulick, Erin R.

AU - Zuelsdorff, Megan

AU - Stites, Shana D.

AU - Arce Rentería, Miguel

AU - Tsoy, Elena

AU - Seblova, Dominika

AU - Ng, Ted K.S.

AU - Manly, Jennifer J.

AU - Babulal, Ganesh

PY - 2023/7

Y1 - 2023/7

N2 - 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.

AB - 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.

KW - ADRD

KW - Alzheimer's disease

KW - Ecological Systems Theory

KW - classism

KW - dementia

KW - genderism

KW - macrosystem

KW - racism

KW - sexism

KW - social determinants of health

KW - structural determinants

KW - Humans

KW - Alzheimer Disease

KW - Social Determinants of Health

KW - Dementia

UR - https://www.scopus.com/pages/publications/85153360049

U2 - 10.1002/alz.13027

DO - 10.1002/alz.13027

M3 - Review article

C2 - 37074203

AN - SCOPUS:85153360049

SN - 1552-5260

VL - 19

SP - 3171

EP - 3185

JO - Alzheimer's and Dementia

JF - Alzheimer's and Dementia

IS - 7

ER -

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

Abstract

Funding

Keywords

UN SDGs

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