Neighborhood Disorder and Dementia Risk in U.S. Older Adults: The Role of Cardiometabolic Risk

Jiao Yu, Yi Wang, Thomas M. Gill and Xi Chen

No 1744, GLO Discussion Paper Series from Global Labor Organization (GLO)

Abstract: We estimate the effect of neighborhood disorder on dementia risk among middle-aged and older adults in the United States and identify cardiometabolic dysregulation as a mediating biological pathway. Using data from the Health and Retirement Study (HRS, 2006-2020), we show that exposure to visible neighborhood disorder is associated with higher risk of dementia (Hazard Ratio: 1.37; 95% CI: 1.08-1.74) and higher risk of cognitive impairment no dementia (CIND; HR: 1.50; 95% CI: 1.22-1.85) over a 14-year follow-up. Mediation analysis reveals that a composite cardiometabolic risk score-aggregating seven biomarkers spanning inflammatory, cardiovascular, and metabolic systems-accounts for approximately 16 percent of the total neighborhood disorder-dementia association and 19 percent of the neighborhood disorder-CIND association. These findings are robust to competing-risk regression for mortality, restriction to non-movers, age-at-onset restrictions, and exclusion of pandemic-year data. The results establish neighborhood disorder as a modifiable upstream risk factor for cognitive decline and identify cardiometabolic health as a biologically proximate mediating pathway. The findings have implications for place-based public health policy: community-level interventions that simultaneously reduce visible signs of neighborhood decay and address cardiometabolic risk may yield dementia-prevention dividends beyond what individual-level clinical strategies alone can achieve.

Keywords: dementia; cognitive impairment; neighborhood disorder; cardiometabolic risk; social determinants of health; mediation analysis (search for similar items in EconPapers)
JEL-codes: I12 I14 J14 R23 (search for similar items in EconPapers)
Date: 2026
New Economics Papers: this item is included in nep-inv and nep-neu
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Working Paper: Neighborhood Disorder and Dementia Risk in U.S. Older Adults: The Role of Cardiometabolic Risk (2026)
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Persistent link: https://EconPapers.repec.org/RePEc:zbw:glodps:1744

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