Narrative

Throughout the pandemic, Michigan was identified by the Centers for Disease Control as a state with high death rates from COVID-19 (Centers for Disease Control and Prevention, 2023). COVID-19 cases were overrepresented among both the Black and Arab/Middle Eastern and North African (MENA) populations in Michigan (Dallo et al., 2023). Yet, what remains unclear is how specific pandemic-related stress experiences varied across racial/ethnic groups. Notably, Michigan is home to the largest, most visible concentration of MENA Americans in the U.S (de la Cruz & Brittingham, 2003), however individuals with ancestry from the Middle East are rarely in studies that focus on contributing risks to health disparities.  In addition to potential racial/ethnic differences in COVID-19 stress, research suggests that MENA Americans have more cognitive limitations compared to their White American counterparts (Dallo, Kindratt, & Zahodne, 2021). Despite evidence for racial/ethnic differences in both COVID-19 and cognitive health, it is unknown whether COVID-19 stress relates to cognitive health differently across groups, which could suggest differential vulnerability or resilience. This study extended previous work by characterizing COVID-19 stress and its relationship to cognitive health among Black, MENA and White Americans in metro-Detroit.

Participants were part of the pioneering Detroit Area Wellness Network – COVID-19 Supplement (DAWN-CS) project. The sample included a total of 600 adults aged 65 years and above, with roughly one third reporting MENA ancestry, one third identifying as Black and another third identifying as White.  All participants completed a30-minute telephone survey from December 2020 through October 2021. This time frame did not include the period of confinement due to the COIVD-19 pandemic (which ended in the summer of 2020). Nevertheless, it involved changing actions and beliefs about how best to contain the virus. December 2020 is when the COVID-19vaccine became available for emergency use (Centers for Disease Control and Prevention, n.d.). This period also saw the emergence of new variants, facemask mandates, and record-level death tolls, especially in communities of color (Centers for Disease Control and Prevention, n.d.). The world continued to face challenges arising from the pandemic, needing to adapt to the changing situation.

Our study found that MENA older adults reported higher levels of economic stress than both Black and White older adults. In addition, MENA older adults were nearly twice as likely to report that they or a household member had COVID-19 symptoms than Black and White older adults. Further, MENA and Black older adults were more likely to report that they knew someone who died from COVID-19, compared to White older adults. The higher levels of these COVID-19stress types for MENA older adults suggest that they might be more susceptible and vulnerable to systemic shocks, including those ushered by health epidemics or pandemics. This finding reflects an accumulating body of research showing racial and ethnic disparities in COVID-19stress (Hoffman 2021; Zhou et al., 2022), particularly among older adults (Buiet al., 2021). The aging MENA American population is largely understudied. Yet, the limited evidence suggests that this aging community may be under-resourced relative to other communities that have had decades to establish response capital, as well as informational and culturally relatable community sources, that can help absorb the effects of such shocks.

Interestingly, higher levels of COVID-19 stress predicted better cognitive health, and the effect was especially apparent among White older adults. The presence of group differences in level of economic stress, experiencing COVID, and/or losing someone known due to COVID is critical for interpreting group differences in the strength of the associations between these stress types and cognition. This could indicate a threshold effect where some stress is beneficial, but too much stress is detrimental. The fact that this is particularly evident for White older adults underscores that socially patterned variations in stress and resources accumulate over the life course to produce advantages in health (Elder& Liker, 1982). For example, being White signifies being part of the majority, which brings with it lower likelihood of negative life events (Barnes & Bennett, 2015) and, potentially, a lower likelihood of facing obstacles in accessing resources because of racial identity (Hedegard, 2018). MENA, Black and White older adults were equally likely to report feeling lonely, as well as to report conflict with family and friends since the start of the pandemic. Higher levels of these types of stressors were associated with worse cognitive health for older adults in all three groups.

Finally, in looking at overall cognitive health, including domains of episodic memory, language, working memory and attention, both Black and White older adults scored better than MENA older adults. After accounting for years of education, White participants still scored higher than MENA participants, while the difference between Black and MENA participants was no longer evident. The addition of immigrant status had a substantial impact. There was no difference between US-born Whites and US-born MENA in cognitive health.  Yet, foreign-born MENA individuals had scored lower, suggesting a need to examine what it is about being an immigrant that puts these older adults at higher risk. Investigating potential modifiable risks, over the continuum of the MENA immigrant lifespan, can provide critical information to help explain cognitive aging challenges, particularly in this underrepresented aging community.

Arab and Middle Eastern American populations have been virtually invisible in the study of both COVID-19 stress and cognitive health generally. Broadening aging and health research by including MENA populations allows us to improve scientific knowledge by clarifying what is universal and what is unique about the effects of stress on cognitive health.

References

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de la Cruz, G. P., & Brittingham, A. (2003). Census 2000 Brief: The Arab Population: 2000. Census.gov. Retrieved September 24, 2023, from https://www.census.gov/library/publications/2003/dec/c2kbr-23.html

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