Gender and Racial/Ethnic Disparities in Social Determinants of Health and Subjective Cognitive Decline: The Mediating Role of Depression

Abstract

Social determinants of health (SDOH) may be associated with subjective cognitive decline (SCD), which is a precursor for Alzheimer’s disease. The main aims of the current study were to examine the association between SDOH and SCD; to determine if there is an indirect pathway among SDOH, depression, and SCD; and to examine the related gender and racial/ethnic disparities. Cross-sectional data were obtained from the 2017 Behavioral Risk Factor Surveillance System Survey (N = 6,509; 2,530 men and 3,978 women aged ≥45 years). Path analyses (stratified by gender and race) were used to determine the relationship between a SDOH index, depression, and SCD. After controlling for gender, age, income, education, employment, and other health-related behaviors, SDOH were positively associated with SCD among the overall population, men, and White populations. SDOH were associated with depression, and depression was associated with SCD among men, women, and White and Black populations. After adjustment for confounders, the indirect pathway among SDOH, depression, and SCD was statistically significant for men (β = 0.035, p < 0.001), women (β = 0.040, p < 0.001), White populations (β = 0.034, p < 0.001), and Black populations (β = 0.036, p = 0.026). Gender and racial/ethnic disparities existed in the relationship among SDOH, depression, and SCD. Future research should assess alternative mediational pathways between SDOH and SCD.