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

Jiao Yu, Yi Wang, Thomas Gill and Xi Chen
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Jiao Yu: Yale University
Yi Wang: Yale University
Thomas Gill: Yale University

No 18581, IZA Discussion Papers from IZA Network @ LISER

Abstract: We estimate the effect of neighborhood disorder on dementia risk and identify cardiometabolic dysregulation as a mediating biological pathway. Using Health and Retirement Study (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% of the total neighborhood disorder–dementia association and 19% 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 findings suggest that community 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: 2026-04
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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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