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Structural and social determinants of dementia risk among adults racialized as Black: Results from a community‐based system dynamics approach
Jean‐Francois Trani, Ramkrishna K. Singh, Alexis I. B. Walker, Semere Bekena, Yiqi Zhu, Jonathan P. Williams, Terri Buckner, Mario Millsap et al.. Alzheimer s & Dementia, 2025-07-01
Topic: Risk, prevention and care in population studies
Plain-language summary
CBSD revealed a framework for how economic hardship, especially low income and unemployment, reduces access to physical and mental healthcare, driving dementia risk. Those from more deprived areas highlighted the need for improved health education, public transportation, healthcare access, and job opportunities. Addressing dementia disparities requires targeting modifiable social and structural drivers. Our findings emphasize the significance of tailored public health interventions that expand access to quality healthcare, reduce socioeconomic barriers, and broadly mitigate racism's pervasive impact on cognitive health. HIGHLIGHTS: Workshop groups from areas with higher neighborhood deprivation (as measured by the Area Deprivation Index [ADI]) were more likely to emphasize stress, poor diet, and limited healthcare access-underscoring the critical influence of socioeconomic disadvantage on both lived experiences and views of dementia risk. Across multiple feedback loops, structural racism emerged as an "external yet ubiquitous" force accelerating other drivers of dementia (e.g., poverty, insufficient community investment, and poorer-quality healthcare), demonstrating the complex pathways by which discrimination exacerbates risk in Black communities. Participants outlined multi-level interventions-ranging from grassroots community programs (e.g., health literacy campaigns, community wellness initiatives) to policy-focused strategies (e.g., political engagement, equitable public resource allocation)-to counteract the self-perpetuating cycle of disadvantage and mitigate dementia risk in under-resourced neighborhoods.
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APA 7th
Trani, J., Singh, R. K., Walker, A. I. B., Bekena, S., Zhu, Y., Williams, J. P., et al. (2025). Structural and social determinants of dementia risk among adults racialized as Black: Results from a community‐based system dynamics approach. Alzheimer s & Dementia. https://doi.org/10.1002/alz.70494
Vancouver
Trani J, Singh RK, Walker AIB, Bekena S, Zhu Y, Williams JP, et al. Structural and social determinants of dementia risk among adults racialized as Black: Results from a community‐based system dynamics approach. Alzheimer s & Dementia. 2025. doi:10.1002/alz.70494. PMID: 40684246.
BibTeX
@article{trani2025-40684246,
author = {Trani, Jean‐Francois and Singh, Ramkrishna K. and Walker, Alexis I. B. and Bekena, Semere and Zhu, Yiqi and Williams, Jonathan P. and Buckner, Terri and Millsap, Mario and others},
title = {{Structural and social determinants of dementia risk among adults racialized as Black: Results from a community‐based system dynamics approach}},
journal = {Alzheimer s \& Dementia},
year = {2025},
doi = {10.1002/alz.70494},
pmid = {40684246},
url = {https://doi.org/10.1002/alz.70494}
}
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Key findings
- CBSD revealed a framework for how economic hardship, especially low income and unemployment, reduces access to physical and mental healthcare, driving dementia risk.
- Those from more deprived areas highlighted the need for improved health education, public transportation, healthcare access, and job opportunities.
- Addressing dementia disparities requires targeting modifiable social and structural drivers.
- Our findings emphasize the significance of tailored public health interventions that expand access to quality healthcare, reduce socioeconomic barriers, and broadly mitigate racism's pervasive impact on cognitive health.
- HIGHLIGHTS: Workshop groups from areas with higher neighborhood deprivation (as measured by the Area Deprivation Index [ADI]) were more likely to emphasize stress, poor diet, and limited healthcare access-underscoring the critical influence of socioeconomic disadvantage on both lived experiences and views of dementia risk.
Why it matters
Using a community-based system dynamics approach, this study described how economic hardship such as low income and unemployment reduces access to physical and mental healthcare and drives dementia risk among adults racialized as Black, with structural racism acting as a force accelerating other drivers. The authors conclude that addressing dementia disparities requires targeting modifiable social and structural drivers through tailored public health interventions, not a medical treatment or cure.
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Study details
- Participants234
- Evidence strengthLow
How this study scored 49/100
Published in a peer-reviewed journal. Scored zero for study design, effect reported and randomized / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Alzheimer s & Dementia) |
| Journal's citation record | 2 / 4 | Alzheimer s & Dementia: journal h-index 228 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 2 / 4 | 234 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomized / blinded | 0 / 2 | No randomization or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 2 / 7 | Cited 11 times (OpenAlex, 2026-10-10) |
| Citations per year | 2 / 5 | 3.7 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 3 / 6 | Cited 7.0× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 2 / 6 | Cited by 3 other studies in this library |
| Still being cited | 1 / 4 | Cited 11 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Ganesh Muneshwar Babulal: h-index 31 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | Washington University in St. Louis: institution h-index 1,962 (OpenAlex) |
| Multicenter collaboration | 2 / 3 | OpenAlex lists 4 institution(s) in 3 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 40684246) |
| Free to read | 2 / 2 | Free to read |
| Total | 49 / 100 | — |
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