Disparities in early life educational environment and AD/ADRD: leveraging administrative linkages in a unique occupational cohort

Abstract Racial disparities in Alzheimer’s disease and related dementias (ADRD) have been well documented. At the same time, there is increasing scientific evidence that early life condition and particularly early-life education are key modifiable risk factors for ADRD. However, there is a critical lack of data and knowledge about how

early-life education may protect against later-life ADRD risk separately for Black and white adults. To fill this gap, we propose to leverage and expand an existing, well documented occupational cohort of autoworkers at General Motors (GM) between 1938-1994. We will use historic census linkages to capture the cohort’s early

life educational environment and linkages with Centers for Medicare and Medicaid Services (CMS) data to capture their chronic conditions and ADRD diagnoses. Importantly, this cohort includes a relatively large number of Black workers, most of whom lived in various parts of the South as children but migrated north to

Michigan by midlife, and all worked at unionized auto plants with good medical benefits. Our central hypothesis is that, despite having similar jobs and access to healthcare in midlife, access to quality education in early life will be related to ADRD risk within racial categories, with a stronger relationship for Black autoworkers.

To examine the association between early life education and ADRD, we will first characterize the cohort’s overall and ADRD disease profile by race by linking the autoworkers cohort with CMS chronic disease files. We will then describe census-level household characteristics (parental education and parental occupation) and

childhood circumstances (racial segregation, child mortality, area wealth, education availability/quality) within Black and white GM autoworkers by linking the UAW-GM cohort with historical census data. Finally, we propose to estimate the association between availability and quality of educational opportunities in childhood

and later-life ADRD risk separately for Black and white UAW-GM workers born 1920-1940. By leveraging a cohort of older adults defined by their similar mid-life work experiences, but with vastly different early life educational opportunities, we can isolate those parts of the education-ADRD relationship that are not mediated

by employment quality or healthcare access in adulthood. The research team includes epidemiologists, a health policy economist, and data analysts with extensive experience working with this cohort, administrative data, and historical census linkage projects. The study team has substantial statistical modeling experience but are relatively new to ADRD research and eager to collect

preliminary data to support future work in this substantive area.