Over‐Representation of Extremely Wealthy Neighborhood Social Exposomes for Brain Donors within Alzheimer’s Disease Research Center Brain Banks assessed by the Neighborhoods Study
Authors: Kind Amy J.H. , Bendlin Barbara B. , Powell W. Ryan , DeWitt Amanda , Cheng Yixuan , Chamberlain Luke , Sharrow Jessica , Boone Brittney Lyons , Abner Erin L. , Alosco Michael L. , Apostolova Liana G. , Bakulski Kelly M. , Barnes Lisa L. , Bateman James R. , Beach Thomas G. , Bennett David A. , Brewer James B. , Carrion Carmen , Chodosh Joshua , Craft Suzanne , Croff Raina , Fabio Anthony , Farias Sarah Tomaszewski , Goldstein Felicia , Henderson Victor W. , Karikari Thomas K , Kofler Julia , Kucharska‐Newton Anna M. , Lamar Melissa , Lanata Serggio , Lepping Rebecca J , Lingler Jennifer H , Lockhart Samuel N. , Mahnken Jonathan D , Marsh Karyn , Meyer Oanh L. , Miller Bruce L. , Morris Jill K , Neugroschl Judith A. , O'Connor Maureen K. , Paulson Henry L , Perrin Richard J. , Pettigrew Corinne , Pierce Aimee , Raji Cyrus A. , Reiman Eric M. , Risacher Shannon L. , Rissman Robert A , Espinoza Patricia Rodriguez , Sano Mary , Saykin Andrew J. , Serrano Geidy E , Soldan Anja , Sultzer David L , Whitmer Rachel A. , Wisniewski Thomas , Woltjer Randall , Zhu Carolyn W. 
Published: January 2025

Background

Adverse social exposome (indexed by national Area Deprivation Index [ADI] 80‐100 or ‘high ADI’) is linked to structural inequities and increased risk of Alzheimer’s disease neuropathology. Twenty percent of the US population resides within high ADI areas, predominantly in inner cities, tribal reservations and rural areas. The percentage of brain donors from high ADI areas within the Alzheimer’s Disease Research Center (ADRC) brain bank system is unknown.

Objective

Determine ADI for brain donors from 21 ADRC sites as part of the on‐going Neighborhoods Study.

Methods

All brain donors in participating ADRC sites with NACC neuropathology data and personal identifiers for ADI linkage (N = 8,637) were included (Figure 1). Geocoded donor addresses were linked to time‐concordant ADI percentiles for year of death.

Results

Overall, only 5.6% of ADRC brain donors (N = 488) resided in a high ADI (disadvantaged) neighborhood at death. The remaining donors resided in more advantaged neighborhoods, with nearly 40% of donors living in the wealthiest quintile of neighborhoods, and over 300 brain donors originating from the wealthiest 1% of US neighborhoods (Figure 2). Donors from high ADI (disadvantaged) neighborhoods identified as 87% White (n = 424), 11% Black (55), 1% Multiracial (6) and <1% other/unknown race (3), with 1% Hispanic (5). None identified as American Indian/Alaska Native or Native Hawaiian/Pacific Islander/Asian. In comparison, donors from low ADI neighborhoods were 94% White (n = 7680), 3% Black (273), 1% Multiracial (75), <1% American Indian/Alaska Native (11), <1% Native Hawaiian/Pacific Islander/Asian (60), and <1% other/unknown race (50), with 3% Hispanic (230). Sex distribution was similar (54%, 51% female, respectively). Inclusion of high ADI donors varied dramatically across the 21 ADRC brain banks from a low of 0.6% to high of 20% of all a site’s donors (Figure 3).

Conclusions

ADI was determined for over 8,600 brain donors in the ADRC system, demonstrating a marked over‐representation of donors from very low ADI (extremely wealthy) neighborhoods, in addition to site‐to‐site variability. This is the first time a comprehensive cross‐sectional social exposome assessment of this nature has been performed, opening windows for additional mechanistic study of the social exposome on brain pathology. Life course ADI assessments are on‐going.