"The Place Where Danger Waits": Ten Years of Incarceration After the 1994 Crime Bill and Cognitive Function among Older Adults.

A likely determinant of cognitive function is incarceration. Structural racism directs adverse policing to differentially patrol groups racialized as Black increasing the chances of incarceration, leading to disproportionate representation in prisons. Direct and indirect exposure to incarceration produces chronic stress and trauma for adults racialized as Black. Due to the unique expansion of U.S. prisons after the Violent Crime Control and Law Enforcement Act of 1994, we examined the association between the 10-year average racialized disparity in prison population for the decade succeeding the Crime Bill, 1995-2005, with the overall 14-year cognitive test performance for older adults racialized as Black living in the same county between 2006 and 2020. This observational study linked the average county-level racialized disparity in U.S. prisons to biannual cognitive performance interviews for mid-to-late life adults racialized as Black (> 50 years; N = 1784) from the Health and Retirement Study using baseline county of residence. Cognitive performance was assessed using a 27-item global cognitive score from the modified Telephone Interview for Cognitive Status administered in-person or online. Mixed-effects regressions estimated that greater incarceration of people racialized as Black in prisons was associated with lower overall cognitive test performance among participants racialized as Black (mean difference per 1000 more incarcerated people per 1000 population racialized as Black vs White = - 0.172, 95% CI = - 0.331, - 0.014). As artist Marvin Gaye sang in his song Flyin' High (in the Friendly Sky), "I go to the place where danger waits me," which describes how structural racism via incarceration disparities occurring in one's surroundings increases cognitive health for people racialized as Black irrespective of population size.