Living in an underserved neighborhood has been linked to all manner of health problems and disadvantages, and a new study adds Alzheimer’s disease to the list. In a paper published June 11 in JAMA Network Open, researchers led by Amy Kind at the University of Wisconsin, Madison, made use of the Neighborhood Atlas—a map of neighborhoods in the United States ranked by their level of disadvantage—to tie the presence of AD neuropathology in postmortem brain samples to the quality of the neighborhood in which the donors had lived. The findings support the idea that social determinants influence neurodegenerative disease, and provide a freely accessible metric that could inform future studies.
- The Neighborhood Atlas ranks neighborhoods by level of advantage.
- Brain donors who had lived in the poorest neighborhood quintile had double the odds of AD brain pathology.
- Brain donors were highly skewed toward affluent neighborhoods.
The Neighborhood Atlas, developed by the Wisconsin researchers, ranks neighborhoods by their area deprivation index (ADI) (Kind et al., 2018). Using U.S. census data, the ADI encompasses multiple factors, including income, employment, and housing quality in a neighborhood.
First author W. Ryan Powell and colleagues asked whether the presence of AD neuropathology among brain donors would associate with the neighborhood where they had last lived. They looked for evidence of amyloid plaques among 447 brains that had been donated to Alzheimer’s Disease Research Centers at the University of Wisconsin, Madison, or at the University of California, San Diego, between 1990 and 2016, and checked the ADI of each donor’s last known address. The donors were strongly skewed toward more affluent neighborhoods; only 24 (5.4 percent) had lived in the most disadvantaged quintile. Consistent with brain donation to the ADRC, 394 (88 percent) of the brains were burdened by Aβ plaques.
Atlas of Advantage. Neighborhoods across the United States are ranked by area deprivation index, with the most disadvantaged areas in dark green. Regions within a 100-mile radius of an ADRC are circled. [Courtesy of Powell et al., JAMA Network Open, 2020.]
The scientists found that people living in the poorest neighborhoods had a higher risk of AD neuropathology, such that for every decile increase in disadvantage, the odds of having plaques rose by 8.1 percent. People who had lived in the most disadvantaged decile had more than double the odds of AD neuropathology than people who lived in the most privileged decile.
The researchers emphasized that ADRC brain donors are not representative of the general U.S. population. In this study, donors had lived an average of 19 miles away from an ADRC, while only 56 percent of the general population live within 100 miles of one. Of those within geographical reach of a center, 13 percent live in the poorest neighborhood quintile, while 30 percent live in the wealthiest. The researchers suggested that expanding ADRCs across the country could help reach a broader population.—Jessica Shugart
- Kind AJ, Buckingham WR. Making Neighborhood-Disadvantage Metrics Accessible - The Neighborhood Atlas. N Engl J Med. 2018 Jun 28;378(26):2456-2458. PubMed.
No Available Further Reading
- Powell WR, Buckingham WR, Larson JL, Vilen L, Yu M, Salamat MS, Bendlin BB, Rissman RA, Kind AJ. Association of Neighborhood-Level Disadvantage With Alzheimer Disease Neuropathology. JAMA Netw Open. 2020 Jun 1;3(6):e207559. PubMed.