Researchers: Paris B Adkins-Jackson, Kristen M George, Lilah M Besser, Jinshil Hyun, Melissa Lamar, Tanisha G Hill-Jarrett, Omonigho M Bubu, Jason D Flatt, Patricia C Heyn, Ethan C Cicero, A Zarina Kraal, Preeti Pushpalata Zanwar, Rachel Peterson, Boeun Kim, Robert W Turner, Jaya Viswanathan, Erin R Kulick, Megan Zuelsdorff, Shana D Stites, Miguel Arce Rentería, Elena Tsoy, Dominika Seblova, Ted K S Ng, Jennifer J Manly, Ganesh Babulal
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.
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Topic: Aging population economics