Exposure to School Racial Segregation and Late-Life Cognitive Outcomes

Geriatrics Neurology Medicine
racial segregation cognitive health educational inequality structural racism late-life cognitive impairment

Academic Report on the Study “Exposure to School Racial Segregation and Late-Life Cognitive Outcomes”

In recent years, the prevalence of Cognitive Impairment and Dementia among the elderly has been on the rise. In the U.S., significant disparities in cognitive health exist between non-Hispanic Black individuals and non-Hispanic White individuals. Research suggests that these disparities may be linked to structural racism in early educational environments, particularly through school racial segregation. School racial segregation involves the separation of students by racial background into different educational institutions, leading to unequal allocation of resources, quality of education, and opportunities. Despite the landmark 1954 “Brown v. Board of Education” ruling that declared school segregation unconstitutional, U.S. educational systems continue to experience heightened levels of racial segregation.

This study aims to explore the association between childhood exposure to school racial segregation and late-life cognitive health, with a focus on differences between Black and White populations. By analyzing nationally representative data from older adults, the study investigates the long-term impact of school segregation on cognitive outcomes and examines mediating factors, such as educational attainment, in this association.

Study Background and Author Information

This research was conducted by Dr. Zhuoer Lin, Dr. Yi Wang, Dr. Thomas M. Gill, and Dr. Xi Chen. The authors are affiliated with the University of Illinois Chicago, Yale School of Public Health, and Yale School of Medicine. The study was published in JAMA Network Open on January 3, 2025, under the title “Exposure to School Racial Segregation and Late-Life Cognitive Outcomes.”

Study Design and Methodology

Data Sources and Sample Selection

The study draws on two primary data sources: 1. School racial segregation data from the U.S. Office for Civil Rights (OCR). 2. Longitudinal survey data from the Health and Retirement Study (HRS).

HRS is a nationally representative survey tracking cognition, sociodemographics, and health characteristics of U.S. residents aged 50 years or older from 1995 to 2018. The study focuses on participants aged 65 and older who self-identified as non-Hispanic Black or non-Hispanic White. The final sample consisted of 3,566 Black participants (16,104 observations) and 17,555 White participants (90,874 observations).

Measuring School Racial Segregation

School segregation was assessed using the Black and White Dissimilarity Index, which scores from 0 to 100. This index measures the percentage of Black students who would need to move to a different school to achieve an equal distribution of Black and White students within a metropolitan area. Higher scores indicate greater segregation. States were categorized as high segregation (≥83.6) or low segregation (<83.6) based on their index quintile.

Cognitive Function Assessment

Cognition was evaluated using the Telephone Interview for Cognitive Status (TICS), a 27-point scale assessing memory, working memory, and processing speed, where higher scores indicate better cognition. Scores below 12 were classified as cognitive impairment, while scores below 7 were indicative of dementia. For participants unable to complete self-reported assessments, proxy evaluations of cognitive impairment and dementia were applied.

Statistical Analysis

The study employed multilevel regression models to analyze the relationship between school segregation and cognitive outcomes. These models accounted for individual, state, and regional variability in segregation exposure. Covariates included age, gender, parental education, and mediators such as educational attainment and midlife health factors (e.g., hypertension, diabetes).

Key Findings

Sample Characteristics

The study included 21,121 participants, with Black individuals constituting 15.1% of the sample and White individuals accounting for 84.9%. High-segregation states had a larger proportion of Black participants (26.4% vs. 11.2%), lower educational attainment, and higher prevalence of health conditions such as hypertension and diabetes.

Association Between School Segregation and Cognitive Outcomes

  • Participants from high-segregation states had lower cognitive scores (13.6 vs. 14.5) and a higher prevalence of cognitive impairment (37.0% vs. 28.0%) and dementia (14.1% vs. 9.3%) compared to those from low-segregation states.
  • Regression analyses revealed a significant negative correlation between school segregation and cognitive outcomes in Black participants but no significant associations in White participants.
  • Mediation analysis indicated that educational attainment explained 57.6% to 72.6% of the observed associations.

Mediators

Educational attainment emerged as a key mediator—high segregation was associated with lower levels of education, which, in turn, contributed to poorer cognitive outcomes. Midlife health conditions like hypertension and smoking seemed to play a minimal role compared to early-life educational disparities.

Conclusions and Implications

This study found that exposure to high levels of school racial segregation during childhood is significantly associated with lower cognitive scores and a higher risk of cognitive impairment and dementia among Black older adults. This relationship was mediated in large part by reduced educational attainment. The study underscores the lasting consequences of structural racism in education and highlights the importance of addressing school racial segregation and educational inequities.

Policy Recommendations

Interventions aimed at reducing school segregation and promoting educational equity could substantially mitigate racial disparities in cognitive outcomes and slow cognitive aging. Clinicians can utilize patients’ early educational background as a marker for higher dementia risk, enabling targeted prevention and management strategies.

Study Strengths

  1. Novel Insights: This study is the first to link historical administrative segregation data with nationwide cognitive outcome data in late life.
  2. Robust Methods: The use of objective segregation measures and a representative sample strengthens the study’s validity.
  3. Policy Relevance: Findings offer actionable guidance for policymakers on reducing health inequities through reforms in education.

Study Limitations

  1. Data Limitations: State-wide segregation indices may not fully capture local nuances, such as urban-rural differences or specific school conditions (e.g., teacher quality).
  2. Causality: As a cross-sectional study, causal relationships between segregation and cognition cannot be definitively determined.
  3. Cognition Assessment: The reliance on self-reported measures for cognitive scores may introduce bias.

Summary

This study highlights the long-term cognitive consequences of childhood exposure to school segregation, particularly in Black populations. The findings provide critical evidence linking structural racism in education with health inequities, reinforcing the need for policies to address educational inequities and promote equity for marginalized populations.