Association of state-level structural racism with subjective cognitive decline prevalence—Behavioral Risk Factor Surveillance System, 2015-2016

This study examines whether exposure to structural racism (SR) is associated with subjective cognitive decline (SCD) among older adults. Data were from the 2010 Structural Racism-Related State Laws Database and the 2015-2016 Behavioral Risk Factor Surveillance System (n = 184 731). Exposure was an index of 22 state laws related to criminal justice, economics, healthcare, housing, immigration, and political participation. SCD was self-reported. In the full sample, results from the adjusted mixed-effects logistic regression model did not provide strong evidence of a difference in the odds of SCD for a two-unit greater SR value (OR = 1.00; 95% CI: 0.99-1.01). Similarly, results derived from the effect measure modification models, including product terms between SR and race/ethnicity, did not provide strong evidence of a difference in odds of SCD for White (OR = 0.99; 95% CI: 0.97-1.02) and Black (OR = 1.00; 95% CI: 0.97-1.02) respondents for a two-unit greater SR value. Conversely, Hispanic (OR = 0.91; 95% CI: 0.88-0.93) and Multiracial (OR = 0.95; 95% CI: 0.93-0.97) adults had lower odds of SCD for a two-unit greater SR value. Age-related differences in the association between SR and SCD were observed, with younger Native Hawaiian/Other Pacific Islanders (OR = 0.91; 95% CI: 0.88-0.94) and older American Indian/Alaska Natives (OR = 0.92; 95% CI: 0.89-0.94) experiencing lower odds of SCD for a two-unit greater SR value.