Background

In the U.S., historical legal and contemporary social segregation results in K-12 school differences based on racial composition. We hypothesize that racial composition of K-12 schools contributes to higher Alzheimer's disease (AD) and related dementia risk among non-Hispanic Black (NHB) older adults.

Objective

To better understand the social determinants of AD, this original research study adopts a life course perspective. Specifically, we investigate associations between K-12 schools' racial composition and later-life cognitive health among U.S.-born and educated NHB older adults.

Methods

We used the Health and Retirement Study's 2015, 2017, and 2019 Life History Mail Survey and categorized participants (N = 2105) by the majority racial composition of K-12 schools they attended: only majority non-Hispanic White (NHW) schools (n = 193), only majority NHB schools (n = 1387), or both school types (n = 525). We used adjusted regressions to assess associations between school racial composition and total cognition, episodic memory, and vocabulary. To examine mediation by educational attainment, we performed path analyses.

Results

Attending only majority NHW schools or attending both school types was associated with better total cognition (p < 0.01 and p < 0.001, respectively) and episodic memory (p < 0.05 and p < 0.01, respectively) compared to only attending majority NHB schools. Attending both school types was also associated with better vocabulary (p < 0.0001). Between 24 and 64% of these associations were mediated by participants' educational attainment.

Conclusions

Our findings highlight the long-term cognitive benefits of attending majority NHW schools for this cohort. These findings also underscore the need for initiatives that promote educational equity in majority NHB schools.

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