Abstract
IMPORTANCE: Black adults may derive long-term cognitive benefits from attendance at a historically Black college or university (HBCU) compared with a predominantly White institution (PWI). This association has not been evaluated in a nationwide sample. OBJECTIVE: To estimate the association between HBCU vs PWI attendance and cognitive health among later-life Black adults. DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from the Reasons for Geographic and Racial Differences in Stroke study, a prospective cohort study that recruited Black and White US adults aged 45 years and older during 2003 to 2007. The national cohort oversampled Black individuals and residents from the Stroke Belt (56%), a group of 8 Southern states defined by excess stroke mortality. The analytic sample included Black participants who attended high school in a state with an HBCU and attended college. Analysis was conducted from February to September 2025. EXPOSURE: Participants self-reported each college ever attended, classified as a PWI (reference) or HBCU. MAIN OUTCOMES AND MEASURES: Assessments of memory, language, and global cognition were conducted during follow-up every 6 months (2006-2021). Cognitive measures were standardized (ie, z-transformed). Linear regression was used to estimate the average treatment effect (ATE) using inverse of probability of treatment weighting. Additional analyses evaluated potential modification by being college-aged before 1955 (during legal racial segregation), 1955 to 1964 (during sanctioned racial discrimination), or after 1964. RESULTS: Among 1978 Black college-goers (mean [SD] age at first assessment, 61.8 [8.2] years; 1333 [67.4%] female), 699 (35.3%) attended an HBCU, 1952 (98.7%) completed a memory assessment, 1970 (99.6%) completed a language assessment, and 530 (26.8%) completed both assessments during the same follow-up visit. Compared with PWI attendance, HBCU attendance was associated with better z-scored memory (ATE, 0.13; 95% CI, 0.05-0.21), language (ATE, 0.19; 95% CI, 0.08-0.29), and global cognition (ATE, 0.22; 95% CI, 0.09-0.34). Estimates were consistent for individuals who were college-aged after 1955 but were not statistically significant among respondents who were college-aged prior to 1955. CONCLUSIONS AND RELEVANCE: In this cohort study using a national dataset, HBCU attendance was associated with better cognition compared with PWI attendance for aging Black adults, which held for those attending college before and after legal racial segregation and sanctioned racial discrimination in education.