Disparities in neighborhood food environment and cognitive decline among US older adults: a cohort study

BackgroundDisparities in neighborhood food environments in the United States, attributed to numerous complex economic, social, and political factors, likely to contribute to disparities in access to healthy food and cognitive function in older adults. However, the role of food environment in cognitive function is not well understood. Accordingly, this study examined the association of residing a low food access and low-income neighborhood with changes in cognitive function among older adults in urban areas.MethodsThis is a cohort study leveraging existing datasets. The 2010 Food Access Research Atlas data was linked to the 2011-2021 National Health and Aging Trends Study (NHATS). A total of 4768 urban-dwelling older adults aged 65 years and older were included in this analysis. Total cognitive function (range: 0-33) was assessed through tests of orientation, executive function, immediate memory, and delayed memory. An unhealthy food environment was defined as residing in census tracts with both low access to healthy food stores and low income. Survey-weighted mixed-effects models were fitted, adjusting for individual- and area-level covariates.ResultsThe mean age of participants was 77.1 years (SD = 7.6), and 2779 were women (weighted % = 56.7). A total of 1238 participants (weighted % = 9.9%) were racialized as Black, 365 (weighted % = 9.1%) racialized as Latinx, and 3165 (weighted % = 81.1%) racialized as White. In adjusted models, older urban- and community-dwelling adults living in neighborhoods with low access and low income had faster annual cognitive decline than their peers (beta = - 0.19; 95% CI = - 0.32, - 0.05).ConclusionsLiving in neighborhoods with both low food access and low income may be a risk factor for accelerated cognitive decline among urban-dwelling older adults and contribute to widening disparities in healthy food access and cognitive decline.