- Social determinants of health in aging
- Cognitive change in the elderly
- Socioeconomic and geographic determinants of stroke incidence and outcomes
- Causal inference in social epidemiology
My research focuses on how social factors experienced across the lifecourse, from infancy to adulthood, influence cognitive function, dementia, stroke, and other health outcomes in old age. I am especially interested in education and other cognitively engaging exposures. Current cohorts of elderly in the US were exposed to profound social changes during the early 20th century when we revolutionized access to high school. One thread of my research examines how changes in schooling laws and school quality in the early 20th century might have influenced the health and cognitive functioning of current cohorts of elderly. My results suggest that extra schooling has substantial benefits for memory function in the elderly independent of any "innate" characteristics.
My recent work has also focused on understanding the social and geographic patterning of stroke and stroke recovery. In the United States, there is a longstanding pattern of excess stroke incidence and mortality suffered by residents of southern states. We are examining whether this might be attributable to early life exposure, rather than adult place of residence. By studying stroke, I hope to improve understanding of factors that influence neurologic risk and resilience and how these conditions are shaped by social inequalities from childhood through adulthood. In particular, the intersection of stroke and dementia is an inadequately understood area.
A separate theme of my research focuses on overcoming methodological problems encountered in analyses of social determinants of health, and cognitive outcomes in particular. For many reasons, research focusing on lifecourse epidemiology as well as cognitive aging introduces substantial methodological challenges. Sometimes, these are conceptual challenges, and clear causal thinking can help! For this reason, I have advocated the use of causal directed acyclic graphs (DAGs) as a standard research tool to represent our causal hypotheses and help elucidate potential biases in proposed analyses. In other cases, the methodological problems require more analytical solutions that have been developed elsewhere in epidemiology or in other disciplines, but are rarely applied to these research questions. Instrumental variables analyses of natural or induced experiments are one promising example.
Students interested in research collaborations related to the social epidemiology of stroke, dementia, and aging are welcome to send me an email.