Educational Attainment and Alzheimer's Disease and Related Dementias (ADRD) Risk Among Black Adults: A Comparative Analysis of U.S.-Born and Non-U.S.-born Populations in the All of Us Research Program.

Objective: To examine the association between educational attainment and Alzheimer's disease and related dementias (ADRD) risk among U.S.-born and non-U.S.-born Black adults. Methods: We conducted a retrospective cohort study using survey and electronic health record data from the All of Us Research Program. ADRD cases were identified using ICD-9/10 codes. Propensity score matching was applied to balance demographic and socioeconomic factors between U.S.-born and non-U.S.-born Black adults aged 65 and older (n = 1412 per group). Results: After matching, ADRD prevalence was higher among non-U.S.-born Black adults (8.1%) than U.S.-born Black adults (7.2%). Among non-U.S.-born Black individuals, higher education was associated with lower ADRD prevalence (7.4% with college + vs. 10.7% with high school or less). Conclusion: Educational attainment may confer differential protective effects against ADRD by nativity. Findings highlight the need to consider nativity, educational context, and early-life structural factors to reduce disparities in cognitive aging and guide targeted ADRD prevention.