Abstract
Social and Demographic Contexts of Rural America and ADRD Risk
Alzheimer’s disease and related dementias (ADRD) represent a growing public health crisis in the United States, with prevalence projected to reach 13.9 million by 2060. Rural residents, and rural women in particular, experience a disproportionate burden of ADRD, yet mechanisms underlying elevated risk and poorer outcomes in rural populations remain poorly understood. Social exposures across the lifecourse are key determinants of later-life cognitive health and ADRD progression, and emerging evidence suggests that rural residence in early life influences ADRD risk independent of residence in later life. However, existing research largely treats rurality as a monolithic exposure, obscuring substantial heterogeneity across US rural contexts and limiting identification of modifiable, contextual determinants of ADRD risk. The overall objective of this pilot project is to evaluate how historical social and demographic characteristics of U.S. rural contexts vary across places and to determine whether these characteristics serve as adverse or protective factors influencing ADRD risk and progression. This study addresses three critical gaps: limited attention to lifecourse residential context; reliance on urban–rural comparisons that obscure within-rural heterogeneity; and insufficient measurement of social and demographic characteristics salient to rural communities, such as dynamic population sizes and composition, social cohesion, institutional trust, and local governance capacity. Using nationally representative data from 17 panels of the General Social Survey (1972–1990), linked to historical US Census demographic indicators, and a diverse subcohort of the Health and Retirement Study with detailed lifecourse residential and schooling histories and repeated cognitive assessments, this project will pursue two aims. Aim 1 will evaluate the extent to which historical social and demographic characteristics of US rural contexts vary independently of local material resources. Aim 2 will assess whether these historical social characteristics in early life are associated with ADRD risk and mortality, independent of individual- and community-level material resources. This project is innovative in conceptualizing rurality as a historically rooted, socially heterogeneous context shaping ADRD risk and progression across the lifecourse. Findings will identify salient social and demographic characteristics of rural environments relevant to ADRD and provide a critical foundation for future NIA K99/R00 or R01 proposals aimed at identifying modifiable, contextual features of US rural communities to improve ADRD risk and outcomes.