Cumulative Unfavorable Social Determinants of Health and AT(N)‐V Pathology in Relation to Cognitive Performance Among Non‐Hispanic Black Men from HABS‐HD

Abstract INTRODUCTION The relationship between social determinants of health (SDoH) burden, Alzheimer's disease–related neuroimaging markers, and cognitive performance among non‐Hispanic Black (NHB) men remains insufficiently characterized. METHODS We analyzed data from 331 NHB males enrolled in the Health and Aging Brain Study–Health Disparities cohort. Participants were categorized into distribution‐based quartiles of a composite cumulative SDoH score. Outcomes included amyloid and tau neuroimaging measures, cortical thickness, hippocampal volume, white matter hyperintensity volume, and cognitive domain composites. RESULTS Greater unfavorable SDoH scores were associated with lower memory ( β = −0.23, p < 0.001), executive function ( β = −0.24, p < 0.001), processing speed ( β = −0.19, p < 0.001), and language ( β = −0.15, p < 0.001). Significant interactions were observed between SDoH quartiles and global amyloid burden for memory ( β = 1.17, 95% confidence interval [CI]: 0.08 to 2.26). SDoH quartiles also significantly interacted with medial temporal lobe tau burden in relation to memory ( β = 0.78, 95% CI: 0.13 to 1.42), executive function ( β = 0.82, 95% CI: 0.23 to 1.41), processing speed ( β = 0.87, 95% CI: 0.26 to 1.47), and language ( β = 0.75, 95% CI: 0.14 to 1.36). Significant interactions between SDoH quartiles and hippocampal volume were observed for memory ( β = −0.17, 95% CI: −0.29 to −0.05) and language ( β = −0.13, 95% CI: −0.25 to −0.02). DISCUSSION The weaker associations between neuroimaging markers and cognition in more unfavorable SDoH suggest that adverse social conditions may contribute to cognitive differences beyond those captured by AT(N)‐V neuroimaging measures.