The structural and social determinants of Alzheimer's disease related dementias

Introduction The projected growth of Alzheimer's disease (AD) and AD‐related dementia (ADRD) cases by midcentury has expanded the research field and impelled new lines of inquiry into structural and social determinants of health (S/SDOH) as fundamental drivers of disparities in AD/ADRD. Methods...

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Published in:Alzheimer's & dementia 2023-07, Vol.19 (7), p.3171-3185
Main Authors: Adkins‐Jackson, Paris B., George, Kristen M., Besser, Lilah M., Hyun, Jinshil, Lamar, Melissa, Hill‐Jarrett, Tanisha G., Bubu, Omonigho M., Flatt, Jason D., Heyn, Patricia C., Cicero, Ethan C., Zarina Kraal, A., Pushpalata Zanwar, Preeti, Peterson, Rachel, Kim, Boeun, Turner, Robert W., Viswanathan, Jaya, Kulick, Erin R., Zuelsdorff, Megan, Stites, Shana D., Arce Rentería, Miguel, Tsoy, Elena, Seblova, Dominika, Ng, Ted K.S., Manly, Jennifer J., Babulal, Ganesh
Format: Article
Language:English
Subjects:
ADRD
Alzheimer Disease
Alzheimer's disease
classism
Dementia
Ecological Systems Theory
genderism
Humans
macrosystem
racism
sexism
Social Determinants of Health
structural determinants
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Summary:Introduction The projected growth of Alzheimer's disease (AD) and AD‐related dementia (ADRD) cases by midcentury has expanded the research field and impelled new lines of inquiry into structural and social determinants of health (S/SDOH) as fundamental drivers of disparities in AD/ADRD. Methods In this review, we employ Bronfenbrenner's ecological systems theory as a framework to posit how S/SDOH impact AD/ADRD risk and outcomes. Results Bronfenbrenner defined the “macrosystem” as the realm of power (structural) systems that drive S/SDOH and that are the root cause of health disparities. These root causes have been discussed little to date in relation to AD/ADRD, and thus, macrosystem influences, such as racism, classism, sexism, and homophobia, are the emphasis in this paper. Discussion Under Bronfenbrenner's macrosystem framework, we highlight key quantitative and qualitative studies linking S/SDOH with AD/ADRD, identify scientific gaps in the literature, and propose guidance for future research. Highlights Ecological systems theory links structural/social determinants to AD/ADRD. Structural/social determinants accrue and interact over the life course to impact AD/ADRD. Macrosystem is made up of societal norms, beliefs, values, and practices (e.g., laws). Most macro‐level determinants have been understudied in the AD/ADRD literature.
ISSN:1552-5260
1552-5279
1552-5279
DOI:10.1002/alz.13027