Neighborhood Disadvantage and Dementia Risk Among Older Patients With Kidney Failure: Differences by Race/Ethnicity and Urbanicity.

RATIONALE &

OBJECTIVE

Among older patients with kidney failure, those who are minoritized or residing in rural areas experience a disproportionate burden of Alzheimer's disease and related dementias (ADRD). Neighborhood disadvantage drives health disparities, but few studies have directly examined its association with ADRD and whether this association varies by race/ethnicity and by urbanicity.

STUDY

DESIGN

Cohort study.

SETTING &

PARTICIPANTS

United States Renal Data System data; older patients (age ≥ 55 years) initiating dialysis in 2003-2021.

EXPOSURES: Residential neighborhood disadvantage was measured using a ZIP-code level index across 9 domains (built environment, criminal justice, education, employment, housing, poverty, social fragmentation, transportation, and wealth).

OUTCOME: ADRD using diagnosis codes.

ANALYTICAL APPROACH: We used cause-specific hazards models to quantify the adjusted hazard ratios (aHR) of ADRD diagnoses. We then used interaction terms to quantify whether these associations differed by race/ethnicity and urbanicity.

RESULTS

After adjustments, older patients in high-disadvantage neighborhoods had a higher risk of ADRD diagnoses (dementia: aHR = 1.09, 95% CI: 1.08-1.10; AD: aHR = 1.25, 95% CI: 1.22-1.27) compared with older patients in low-disadvantage neighborhoods; these associations differed by race/ethnicity (dementia: P interaction = 0.03; AD: P interaction = 0.002) and urbanicity (P interactions < 0.001 for both). Specifically, older Black patients in high-disadvantage neighborhoods had a higher risk of ADRD (dementia: aHR = 1.19, 95% CI: 1.17-1.21; AD: aHR = 1.31, 95% CI:1.28-1.35) compared with older Black patients in low-disadvantage neighborhoods. Within suburban, rural, and small-town areas, older patients residing in high-disadvantage neighborhoods had a higher risk of ADRD compared with those in low-disadvantage neighborhoods.

LIMITATIONS: ZIP codes as a proxy for neighborhoods.

CONCLUSIONS

Older patients with kidney failure residing in high-disadvantage neighborhoods, particularly Black patients and those in suburban, rural, or small-town areas, had a higher risk of ADRD compared with those in low-disadvantage neighborhoods. Multifaceted interventions (eg, cognitive screening, collaborative care) are needed to mitigate structural barriers associated with neighborhood disadvantage and preserve cognitive function in this population.