{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T12:03:56Z","timestamp":1768565036137,"version":"3.49.0"},"posted":{"date-parts":[[2023,4,26]]},"group-title":"Epidemiology","reference-count":65,"publisher":"openRxiv","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2023,4,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:p>We evaluated the role of the neurotoxicant lead (Pb) in mediating racial disparities in later-life cognition in 1,085 non-Hispanic Black and 2,839 non-Hispanic white participants in NHANES (1999-2002, 2011-2014) 60+ years of age. We operationalized Black race as a marker for the experience of racialization and exposure to systemic racism. We estimated patella bone Pb via predictive models using blood Pb and demographics. Concurrent cognition (processing speed, sustained attention, working memory) was measured by the Digit Symbol Substitution Test (DSST) and a global measure combining four cognitive tests. To obtain the portion mediated, we used regression coefficients (race on Pb * Pb on cognitive score)\/(race on cognitive score), adjusting for age, NHANES cycle, and sample weights. Other confounder adjustment (education, poverty income ratio, smoking) was limited to the mediator-outcome (i.e., Pb-cognition) pathway because these factors do not lie upstream of race and so cannot confound associations with race. Pb was estimated to mediate 0.6% of the association between race and global cognition, and 4% of the DSST. Our results suggest that later-life cognitive health disparities may be impacted by avoidable lead exposure driven by environmental injustice, noting that a large proportion of the pathway of systemic racism harming cognition remains.<\/jats:p>","DOI":"10.1101\/2023.04.22.23288920","type":"posted-content","created":{"date-parts":[[2023,4,26]],"date-time":"2023-04-26T13:35:17Z","timestamp":1682516117000},"source":"Crossref","is-referenced-by-count":0,"title":["Racialized experience, biomarkers of lead exposure, and later-life cognition: a mediation analysis"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7967-2800","authenticated-orcid":false,"given":"Tara E.","family":"Jenson","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelly M.","family":"Bakulski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linda","family":"Wesp","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keith","family":"Dookeran","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ira","family":"Driscoll","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy E.","family":"Kalkbrenner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2023042813300899000_2023.04.22.23288920v1.1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0035-1555115"},{"key":"2023042813300899000_2023.04.22.23288920v1.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroimage.2012.03.088"},{"key":"2023042813300899000_2023.04.22.23288920v1.3","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2014-310095"},{"key":"2023042813300899000_2023.04.22.23288920v1.4","doi-asserted-by":"publisher","DOI":"10.1177\/1533317520960874"},{"key":"2023042813300899000_2023.04.22.23288920v1.5","doi-asserted-by":"publisher","DOI":"10.1093\/geronb\/gby056"},{"key":"2023042813300899000_2023.04.22.23288920v1.6","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0000000000000747"},{"key":"2023042813300899000_2023.04.22.23288920v1.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2022.115298"},{"key":"2023042813300899000_2023.04.22.23288920v1.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jalz.2008.03.001"},{"key":"2023042813300899000_2023.04.22.23288920v1.9","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2011.300544"},{"key":"2023042813300899000_2023.04.22.23288920v1.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2010.07.030"},{"key":"2023042813300899000_2023.04.22.23288920v1.11","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17051552"},{"key":"2023042813300899000_2023.04.22.23288920v1.12","doi-asserted-by":"publisher","DOI":"10.3233\/JAD-200282"},{"key":"2023042813300899000_2023.04.22.23288920v1.13","doi-asserted-by":"publisher","DOI":"10.1289\/ehp.7688"},{"key":"2023042813300899000_2023.04.22.23288920v1.14","doi-asserted-by":"publisher","DOI":"10.1136\/oem.55.8.507"},{"key":"2023042813300899000_2023.04.22.23288920v1.15","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.1712"},{"key":"2023042813300899000_2023.04.22.23288920v1.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.envres.2016.10.007"},{"key":"2023042813300899000_2023.04.22.23288920v1.17","doi-asserted-by":"publisher","DOI":"10.1097\/EE9.0000000000000045"},{"key":"2023042813300899000_2023.04.22.23288920v1.18","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwh333"},{"key":"2023042813300899000_2023.04.22.23288920v1.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.envres.2016.07.034"},{"key":"2023042813300899000_2023.04.22.23288920v1.20","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/154.4.291"},{"key":"2023042813300899000_2023.04.22.23288920v1.21","unstructured":"Public Health Leadership Society, Centers for Disease Control and Prevention. 2002. Principles of the ethical practice of public health. Version 2.2. Available: https:\/\/stacks.cdc.gov\/view\/cdc\/5595 [accessed 6 April 2023]."},{"key":"2023042813300899000_2023.04.22.23288920v1.22","unstructured":"(was 21)CDC\/National Center for Health Statistics. 2022. NHANES -About the National Health and Nutrition Examination Survey. Available: https:\/\/www.cdc.gov\/nchs\/nhanes\/about_nhanes.htm [accessed 3 February 2023]."},{"key":"2023042813300899000_2023.04.22.23288920v1.23","unstructured":"CDC\/National Center for Health Statistics. 2017a. NHANES 2011-2012 Cognitive Functioning Data Documentation, Codebook, and Frequencies. Available: https:\/\/www.n.cdc.gov\/Nchs\/Nhanes\/2011-2012\/CFQ_G.htm [accessed 15 March 2021]."},{"key":"2023042813300899000_2023.04.22.23288920v1.24","unstructured":"CDC\/National Center for Health Statistics. 2005. NHANES 2001-2002: Cognitive Functioning Data Documentation, Codebook, and Frequencies (CFQ_B). Available: https:\/\/www.n.cdc.gov\/Nchs\/Nhanes\/2001-2002\/CFQ_B.htm [accessed 2 May 2021]."},{"key":"2023042813300899000_2023.04.22.23288920v1.25","unstructured":"CDC\/National Center for Health Statistics. 2015. NHANES 2011-2012: Demographic Variables & Sample Weights. Available: https:\/\/www.n.cdc.gov\/Nchs\/Nhanes\/2011-2012\/DEMO_G.htm [accessed 29 March 2021]."},{"key":"2023042813300899000_2023.04.22.23288920v1.26","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0000000000000105"},{"key":"2023042813300899000_2023.04.22.23288920v1.27","doi-asserted-by":"crossref","unstructured":"Park SK , Mukherjee B , Xia X , Sparrow D , Weisskopf MG , Nie H , et al. 2009. Bone Lead Level Prediction Models and Their Application to Examining the Relationship of Lead Exposure and Hypertension in the Third National Health and Nutrition Examination Survey","DOI":"10.1097\/JOM.0b013e3181bf6c8d"},{"key":"2023042813300899000_2023.04.22.23288920v1.28","unstructured":"CDC\/National Center for Health Statistics. 2007a. NHANES 1999-2000: Cadmium, Lead, Mercury, Cotinine & Nutritional Biochemistries Data Documentation, Codebook, and Frequencies. Available: https:\/\/www.n.cdc.gov\/Nchs\/Nhanes\/1999-2000\/LAB06.htm [accessed 6 February 2023]."},{"key":"2023042813300899000_2023.04.22.23288920v1.29","unstructured":"CDC\/National Center for Health Statistics. 2007b. NHANES 2001-2002: Cadmium, Lead, Mercury, Cotinine & Nutritional Biochemistries Data Documentation, Codebook, and Frequencies. Available: https:\/\/www.n.cdc.gov\/Nchs\/Nhanes\/2001-2002\/L06_B.htm x[accessed 6 February 2023]."},{"key":"2023042813300899000_2023.04.22.23288920v1.30","unstructured":"CDC\/National Center for Health Statistics. 2013b. NHANES 2011-2012: Cadmium, Lead, Total Mercury, Selenium, & Manganese -Blood Data Documentation, Codebook, and Frequencies. Available: https:\/\/www.n.cdc.gov\/Nchs\/Nhanes\/2011-2012\/PBCD_G.htm x[accessed 15 March 2021]."},{"key":"2023042813300899000_2023.04.22.23288920v1.31","unstructured":"CDC\/National Center for Health Statistics. 2016a. NHANES 2013-2014: Lead, Cadmium, Total Mercury, Selenium, & Manganese -Blood Data Documentation, Codebook, and Frequencies. Available: https:\/\/www.n.cdc.gov\/Nchs\/Nhanes\/2013-2014\/PBCD_H.htm x[accessed 6 February 2023]."},{"key":"2023042813300899000_2023.04.22.23288920v1.32","unstructured":"CDC\/National Center for Health Statistics. 2014. Blood Metals in Whole Blood NHANES 2013-2014. Available: https:\/\/www.n.cdc.gov\/nchs\/data\/nhanes\/2013-2014\/labmethods\/PbCd_H_MET.pdf x[accessed 6 February 2023]."},{"key":"2023042813300899000_2023.04.22.23288920v1.33","unstructured":"CDC\/National Center for Health Statistics. 2002. NHANES 1999-2000: Body Measures Data Documentation, Codebook, and Frequencies. Available: https:\/\/www.n.cdc.gov\/Nchs\/Nhanes\/1999-2000\/BMX.htm [accessed 6 February 2023]."},{"key":"2023042813300899000_2023.04.22.23288920v1.34","unstructured":"CDC\/National Center for Health Statistics. 2015. NHANES 2011-2012: Demographic Variables & Sample Weights. Available: https:\/\/www.n.cdc.gov\/Nchs\/Nhanes\/2011-2012\/DEMO_G.htm [accessed 29 March 2021]."},{"key":"2023042813300899000_2023.04.22.23288920v1.35","unstructured":"CDC\/National Center for Health Statistics. 2016b. NHANES 2013-2014: Smoking - Cigarette Use Data Documentation, Codebook, and Frequencies. Available: https:\/\/www.n.cdc.gov\/Nchs\/Nhanes\/2013-2014\/SMQ_H.htm x[accessed 6 February 2023]."},{"key":"2023042813300899000_2023.04.22.23288920v1.36","doi-asserted-by":"publisher","DOI":"10.1136\/tc.2005.015073"},{"key":"2023042813300899000_2023.04.22.23288920v1.37","unstructured":"CDC\/National Center for Health Statistics. 2013c. NHANES 2011-2012: Cotinine - Serum & Total NNAL - Urine Data Documentation, Codebook, and Frequencies. Available: https:\/\/www.n.cdc.gov\/Nchs\/Nhanes\/2011-2012\/COTNAL_G.htm x[accessed 6 February 2023]."},{"key":"2023042813300899000_2023.04.22.23288920v1.38","unstructured":"CDC\/National Center for Health Statistics. 2017b. NHANES 2013-2014: Cotinine and Hydroxycotinine - Serum Data Documentation, Codebook, and Frequencies. Available: https:\/\/www.n.cdc.gov\/Nchs\/Nhanes\/2013-2014\/COT_H.htm x[accessed 6 February 2023]."},{"key":"2023042813300899000_2023.04.22.23288920v1.39","unstructured":"Berglund PA . 2018. Using SAS\u00ae for Multiple Imputation and Analysis of Longitudinal Data. Available: https:\/\/www.sas.com\/content\/dam\/SAS\/support\/en\/sas-global-forum-proceedings\/2018\/1738-2018.pdf x[accessed 8 February 2023]."},{"key":"2023042813300899000_2023.04.22.23288920v1.40","unstructured":"CDC\/National Center for Health Statistics. 2020. NHANES Tutorials - Module 3 - Weighting. Available: https:\/\/www.n.cdc.gov\/nchs\/nhanes\/tutorials\/module3.aspx x[accessed 27 March 2021]."},{"key":"2023042813300899000_2023.04.22.23288920v1.41","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2016.05.042"},{"key":"2023042813300899000_2023.04.22.23288920v1.42","unstructured":"Berchtold SR and A. 2020. RBtest: Regression-Based Approach for Testing the Type of Missing Data."},{"key":"2023042813300899000_2023.04.22.23288920v1.43","unstructured":"R Core Team (2022). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. URL https:\/\/www.R-project.org\/."},{"key":"2023042813300899000_2023.04.22.23288920v1.44","unstructured":"Pyle K. 1918. Mother\u2019s Nursery Tales. Project Gutenberg. Available: https:\/\/www.gutenberg.org\/files\/49001\/49001-h\/49001-h.htm x[accessed 6 April 2023]."},{"key":"2023042813300899000_2023.04.22.23288920v1.45","doi-asserted-by":"publisher","DOI":"10.1037\/0022-3514.51.6.1173"},{"key":"2023042813300899000_2023.04.22.23288920v1.46","doi-asserted-by":"publisher","DOI":"10.6018\/analesps.29.2.139241"},{"key":"2023042813300899000_2023.04.22.23288920v1.47","doi-asserted-by":"publisher","DOI":"10.1037\/a0031034"},{"key":"2023042813300899000_2023.04.22.23288920v1.48","doi-asserted-by":"publisher","DOI":"10.1080\/03610918.2019.1568472"},{"key":"2023042813300899000_2023.04.22.23288920v1.49","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.331.7521.903"},{"key":"2023042813300899000_2023.04.22.23288920v1.50","doi-asserted-by":"publisher","DOI":"10.1037\/pag0000154"},{"key":"2023042813300899000_2023.04.22.23288920v1.51","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/glab099"},{"key":"2023042813300899000_2023.04.22.23288920v1.52","doi-asserted-by":"publisher","DOI":"10.1093\/geronb\/gbab202"},{"key":"2023042813300899000_2023.04.22.23288920v1.53","doi-asserted-by":"publisher","DOI":"10.1016\/j.envint.2020.105496"},{"key":"2023042813300899000_2023.04.22.23288920v1.54","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2007.118505"},{"key":"2023042813300899000_2023.04.22.23288920v1.55","doi-asserted-by":"publisher","DOI":"10.1016\/j.envres.2013.12.010"},{"key":"2023042813300899000_2023.04.22.23288920v1.56","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0b013e3181b5f100"},{"key":"2023042813300899000_2023.04.22.23288920v1.57","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph19042327"},{"key":"2023042813300899000_2023.04.22.23288920v1.58","doi-asserted-by":"publisher","DOI":"10.1007\/s11065-008-9066-x"},{"key":"2023042813300899000_2023.04.22.23288920v1.59","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.73.4.385"},{"key":"2023042813300899000_2023.04.22.23288920v1.60","doi-asserted-by":"publisher","DOI":"10.1016\/j.acn.2004.06.001"},{"key":"2023042813300899000_2023.04.22.23288920v1.61","doi-asserted-by":"publisher","DOI":"10.1007\/s11065-008-9067-9"},{"key":"2023042813300899000_2023.04.22.23288920v1.62","doi-asserted-by":"crossref","unstructured":"Manly JJ . 2008. Handbook of Cognitive Aging: Interdisciplinary Perspectives. In: Handbook of Cognitive Aging: Interdisciplinary Perspectives. SAGE Publications, Inc.:Thousand Oaks. 398\u2013417.","DOI":"10.4135\/9781412976589.n25"},{"key":"2023042813300899000_2023.04.22.23288920v1.63","doi-asserted-by":"publisher","DOI":"10.1093\/geronb\/53B.6.P370"},{"key":"2023042813300899000_2023.04.22.23288920v1.64","doi-asserted-by":"publisher","DOI":"10.1016\/j.jalz.2015.06.1885"},{"key":"2023042813300899000_2023.04.22.23288920v1.65","doi-asserted-by":"publisher","DOI":"10.1093\/geronb\/gbt133"}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1101\/2023.04.22.23288920","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T19:32:22Z","timestamp":1768505542000},"score":1,"resource":{"primary":{"URL":"http:\/\/medrxiv.org\/lookup\/doi\/10.1101\/2023.04.22.23288920"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,26]]},"references-count":65,"URL":"https:\/\/doi.org\/10.1101\/2023.04.22.23288920","relation":{"is-preprint-of":[{"id-type":"doi","id":"10.1093\/aje\/kwae194","asserted-by":"subject"}]},"subject":[],"published":{"date-parts":[[2023,4,26]]},"subtype":"preprint"}}