“The place where danger waits”: Ten years of the 1994 Crime Bill incarceration on cognitive function in older adults racialized as Black

Background Structural racism may drive the constellation of structural determinants that increase racialized disparities in the risk for Alzheimer’s disease related dementias (ADRD). Structural racism via adverse policing increases exposure to negative police encounters that produce heightened vigilance, anxiety, and depressed mood in persons racialized as Black. Seminal research suggests high‐police contact and disparities in Black‐White incarceration are positively associated with risk for other health conditions. It is feasible that cumulative stress from anticipatory and recurrent police encounters disrupts the body’s homeostasis leading to accelerated cognitive aging. Method We used US county‐level incarceration data to compute the Black‐White difference in prison and jail rates for US counties between 1995‐2005 (succeeding the 1994 Crime Bill). We then averaged the decade and linked said data by county to individual‐level health data for participants racialized as Black >50 years in the Health and Retirement Study (N = 2,300) who completed the core interview between 2006‐18 (mean observation of 3.4 per participant). Cognitive function was assessed using a 27‐item global cognitive score from the modified Telephone Interview for Cognitive Status. A mixed effects model was used to estimate the cognitive effect of a one‐unit change in incarceration (1,000 additional persons racialized as Black compared to White) with covariates of age at baseline, gender, education, and living arrangement. Result Greater Black‐White 10‐year difference in prison population was significantly associated with worse 2006 cognitive function (β ‐1.08, SE .45, 95% CI ‐1.96,‐.22). The adjusted model was significant for Black‐White difference in prison population with cognitive decline starting in 2006 (β .011, SE .006, 95% CI ‐.001, .023). The Black‐White difference in jail population was not significant. Conclusion Ten‐year Black‐White disparities in prison population are associated with cognitive decline among people racialized as Black starting one year later. While the 1994 Crime Bill is a decades‐old federal policy, it put into place a fiscal infrastructure which local governments continue to use to fund prisons, increase average prison time, and implement adverse policing quotas. These findings suggest structural racism via adverse policing is meaningful to explore in the context of ADRD.