BACKGROUND AND OBJECTIVES Race and ethnicity are proxy measures of sociocultural factors that influence cognitive test performance. Our objective was to compare different regression-based cognitive normative models adjusting for demographics and different combinations of easily accessible/commonly used social determinants of health (SDoH) factors, which may help describe cognitive performance variability historically captured by ethnoracial differences. METHODS We performed cross-sectional analyses on data from Black and White participants without mild cognitive impairment/dementia in the Atherosclerosis Risk in Communities Study who attended visit 5 in 2011-2013. Participants underwent a battery of 11 cognitive tests (3 domains: memory, executive function, language). We fit 6 separate normative models for each cognitive test, all including age and education, with different combinations of race, the Wide Range of Achievement Test (education quality proxy), and area deprivation index (neighborhood deprivation) associated with current residence. We compared model fits and calculated concordances/discordances between models using z-scores derived from each normative model and a z-score <-1.5 threshold for impairment. RESULTS Participants (n = 2,392) had a mean age of 74.4 years, 60.4% were female, and 17.1% were of self-reported Black race. The "Full" model with race alongside demographic and SDoH measures consistently outperformed other nested submodels (likelihood ratios ≥ 100) for all domains/tests except Delayed Word Recall. Models with education quality alone ("WRAT") generally outperformed models with neighborhood deprivation ("ADI") or race ("Race") alone for memory and language tests while "Race" models performed better for executive function tests. Adding neighborhood deprivation to education quality ("WRAT + ADI") did not improve models vs using "WRAT" alone. Across all domains/tests, the concordance compared with the "Full" model was lower for "Education" and "ADI" models than for other nested models. Although numbers were small, there was greater discordance among Black (range = 8.2%-23.2%) compared with White (range = 2.2%-3.4%) participants, particularly for Boston Naming Test and executive function tests. DISCUSSION Education quality outperformed neighborhood disadvantage as an additional/alternative SDoH measure in normative models and may be useful to collect in cognitive aging studies. While performance varied across cognitive domains and tests, routinely reported SDoH variables (education level, education quality, late-life neighborhood deprivation) did not fully account for observed ethnoracial variability; future work should evaluate SDoH across the lifespan in more ethnoracially diverse populations.

中文翻译：

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评估基于健康的基于种族的认知规范模型的替代方案的社会决定因素。


背景和目标 种族和民族是影响认知测试表现的社会文化因素的代理衡量标准。我们的目标是比较不同的基于回归的认知规范模型，这些模型根据人口统计学进行调整，以及易于访问/常用的健康社会决定因素 （SDoH） 因素的不同组合，这可能有助于描述历史上由种族差异捕获的认知表现变异性。方法 我们对社区动脉粥样硬化风险研究中没有轻度认知障碍/痴呆的黑人和白人参与者的数据进行了横断面分析，这些参与者在 2011-2013 年参加了第 5 次访问。参与者接受了 11 项认知测试（3 个领域：记忆、执行功能、语言）。我们为每个认知测试拟合了 6 个单独的规范模型，所有模型都包括年龄和教育程度，以及与当前居住相关的种族、广泛成就测试（教育质量代理）和区域剥夺指数（邻里剥夺）的不同组合。我们使用来自每个规范模型得出的 z 分数和损伤的 z 分数 <-1.5 阈值比较模型拟合并计算模型之间的一致性/不一致。结果 参与者 （n = 2,392） 的平均年龄为 74.4 岁，60.4% 为女性，17.1% 为自我报告的黑人。除延迟单词回忆外，种族与人口统计和 SDoH 测量一起的“完整”模型在所有领域/测试中始终优于其他嵌套子模型（似然比≥ 100）。在记忆和语言测试中，仅具有教育质量 （“WRAT”） 的模型通常优于具有邻里剥夺 （“ADI”） 或单独具有种族 （“Race”） 的模型，而“Race”模型在执行功能测试中的表现较好。 与单独使用 “WRAT” 相比，将社区剥夺添加到教育质量 （“WRAT + ADI”） 并没有改进模型。在所有领域/测试中，“Education” 和 “ADI” 模型的一致性与 “Full” 模型相比低于其他嵌套模型。尽管数字很小，但黑人（范围 = 8.2%-23.2%）参与者与白人（范围 = 2.2%-3.4%）参与者之间存在更大的不一致，尤其是在波士顿命名测试和执行功能测试方面。讨论 在规范模型中，教育质量作为附加/替代 SDoH 测量优于邻里劣势，可能有助于在认知衰老研究中收集。虽然表现因认知领域和测试而异，但常规报告的 SDoH 变量（教育水平、教育质量、晚年社区剥夺）并未完全解释观察到的种族变异性;未来的工作应该在种族更多样化的人群中评估 SDoH 在整个生命周期中的作用。