About

Dr. Karen D. Lincoln is a professor of environmental and occupational health and the director of the Center for Environmental Health Disparities Research in the Program in Public Health at the University of California, Irvine. She is a social worker and sociologist with expertise in social determinants of health disparities. Her research, writing, and advocacy are rooted in the Black American experience and span the fields of social work, sociology, and gerontology. Her primary research objective is to improve health and well-being outcomes for Black Americans, older adults, and minoritized persons by investigating the psychosocial, behavioral, and biological mechanisms that link social determinants to health and well-being. Dr. Lincoln is the founder and director of Advocates for African American Elders, an outreach, engagement, and health education program serving older adults and their families throughout Southern California. She has published extensively on social stress, aging, and health disparities, and is an active public scholar and aging advocate, with op-eds in prominent media outlets such as the New York Times and the Wall Street Journal. She is recognized as a fellow of the Gerontological Society of America, a Hartford Faculty Scholar, an Encore Public Voices Fellow, and a Next Avenue Influencer in Aging. Her scholarly work has contributed significantly to understanding the impact of social interactions on mental health among African American and Caribbean Black adults, advancing knowledge on social support, negative interactions, and mental health outcomes within diverse populations.

Research topics

• Medicine
• Psychology
• Psychiatry
• Sociology
• Clinical psychology
• Gerontology
• Demography
• Gender studies
• Environmental health
• Internal medicine
• Social psychology

Selected publications

• Association of Historical Redlining With Gestational Diabetes Mellitus: The Mediating Role of BMI and Area Deprivation Index

  Diabetes Care · 2025-02-12 · 1 citations

  articleOpen access

  OBJECTIVE: We investigated the association between historic redlining and risk of gestational diabetes mellitus (GDM) and whether this relationship is mediated by maternal obesity and area-level deprivation. RESEARCH DESIGN AND METHODS: This retrospective study included 86,834 singleton pregnancies from Kaiser Permanente Southern California's health records (2008-2018). Redlining was assessed using digitized Home Owners' Loan Corporation (HOLC) maps, with patients' residential addresses geocoded and assigned HOLC grades (A, B, C, or D) based on their geographic location within HOLC-graded zones. For GDM case patients, exposure was assigned based on address at diagnosis date; for noncase patients, it was assigned based on address during the 24th to 28th gestational week. Health records were combined with area deprivation index (ADI) from 2011 to 2015 census data. Mixed-effect logistic regression models assessed associations between redlining and GDM, with mediation by BMI and ADI evaluated using inverse odds ratio weighting. Models were adjusted for maternal age, education, race and ethnicity, neighborhood-level income, and smoking status. RESULTS: Among the 10,134 (11.67%) GDM case patients, we found increased risk of GDM in B ("still desirable," adjusted odds ratio [aOR] 1.20, 95% CI 0.99-1.44), C-graded ("definitely declining," aOR 1.22, 95% CI 1.02-1.47), and D-graded ("hazardous," i.e., redlined, aOR 1.30, 95% CI 1.08-1.57) neighborhoods compared with the "best"-graded zone. Prepregnancy BMI and ADI mediated 44.2% and 64.5% of the increased GDM risk among mothers in redlined areas. CONCLUSIONS: Historic redlining is associated with an increased risk of GDM, mediated by maternal obesity and neighborhood deprivation. Future research is needed to explore the complex pathways linking redlining to pregnancy outcomes.

  PublisherOA PDFDOI

• Living-Donor Kidney Transplantation by Insurance Coverage over Two Decades

  Journal of the American Society of Nephrology · 2025-10-01

  article
  PublisherDOI

• Clinical criteria for limbic‐predominant age‐related TDP‐43 encephalopathy

  Alzheimer s & Dementia · 2025-01-01 · 66 citations

  reviewOpen access

  Limbic predominant age-related TDP-43 encephalopathy neuropathologic change (LATE-NC) is highly prevalent in late life and a common co-pathology with Alzheimer's disease neuropathologic change (ADNC). LATE-NC is a slowly progressive, amnestic clinical syndrome. Alternatively, when present with ADNC, LATE-NC is associated with a more rapid course. With the emergence of anti-amyloid therapeutics, discrimination of LATE-NC from ADNC is critical and will lead to greater clinical recognition of amnestic patients without ADNC. Furthermore, co-pathology with LATE-NC may influence outcomes of these therapeutics. Thus there is a need to identify patients during life with likely LATE-NC. We propose criteria for clinical diagnosis of LATE as an initial framework for further validation. In the context of progressive memory loss and substantial hippocampal atrophy, criteria are laid out for probable (amyloid negative) or possible LATE (amyloid biomarkers are unavailable or when amyloid is present, but hippocampal neurodegeneration is out of proportion to expected pure ADNC). HIGHLIGHTS: Limbic-predominant age-related TDP-43 encephalopathy (LATE) is a highly prevalent driver of neuropathologic memory loss in late life. LATE neuropathologic change (LATE-NC) is a common co-pathology with Alzheimer's disease neuropathologic change (ADNC) and may influence outcomes with emerging disease-modifying medicines. We provide initial clinical criteria for diagnosing LATE during life either when LATE-NC is the likely primary driver of symptoms or when observed in conjunction with AD. Definitions of possible and probable LATE are provided.

  PublisherOA PDFDOI

• Racial and Ethnic Disparities in Outcomes following Preemptive Kidney Transplant Waitlisting in the United States from 2009 to 2024

  Journal of the American Society of Nephrology · 2025-09-16

  articleOpen access

  Key Points Among US preemptively waitlisted patients with CKD, deceased donor transplants increased for Black and Hispanic patients, comparable with White patients. Dialysis initiation was higher for waitlisted Asian, Black, and Hispanic patients compared with White patients, mirroring lower living donor transplants. Organ Procurement and Transplantation Network wait time credit and Increasing Organ Transplant Access metric could expand preemptive transplantation. Background Preemptive kidney transplantation (before dialysis initiation) is the optimal therapy for most transplant-eligible advanced patients with CKD. Although prior research has documented racial and ethnic disparities in preemptive referrals, less is known about distinct outcomes after preemptive waitlisting. This study examines the association between race and ethnicity and outcomes for preemptively waitlisted patients. Methods We conducted a secondary analysis of a prospectively maintained US cohort using data from the Scientific Registry of Transplant Recipients. The study population included 98,863 adult first-time kidney transplant candidates who were preemptively waitlisted from January 1, 2009, to December 31, 2020, and followed through December 31, 2024. The exposure of interest was race and ethnicity. The primary outcome was 3-year preemptive deceased donor kidney transplantation, living donor kidney transplantation, or dialysis initiation. We used competing risk models to estimate adjusted subdistribution hazard ratios (aSHRs). Data were stratified into 3-year intervals (2009–2011, 2012–2014, 2015–2017, and 2018–2020). Results Black and Hispanic patients received preemptive deceased donor kidney transplants as often as White patients (era 2018–2020, aSHRs [95% confidence interval (CI)]: 0.99 [95% CI, 0.92 to 1.07] and 1.02 [95% CI, 0.93 to 1.12], respectively), while Asian patients had lower rates (0.78 [95% CI, 0.69 to 0.88]). However, Asian, Black, and Hispanic patients were more likely to initiate dialysis (aSHRs: 1.50 [95% CI, 1.39 to 1.61]; 1.41 [95% CI, 1.34 to 1.49]; and 1.21 [95% CI, 1.14 to 1.29], respectively) and were less likely to receive preemptive living donor kidney transplants than White patients (era 2018–2020, aSHRs: 0.49 [95% CI, 0.44 to 0.54]; 0.31 [95% CI, 0.29 to 0.34]; and 0.61 [95% CI, 0.56 to 0.66], respectively). Conclusions Among waitlisted patients with CKD in the United States between 2009 and 2020, rates of preemptive deceased donor kidney transplantation improved for Black and Hispanic patients and became comparable with White patients. However, Asian, Black, and Hispanic patients experienced higher rates of dialysis initiation and lower rates of preemptive living donor kidney transplantation.

  PublisherOA PDFDOI

• Association of Historical Redlining with Gestational Diabetes Mellitus: The Mediating Role of Body Mass Index and Area Deprivation Index

  2025-02-12

  preprintOpen access

  <p dir="ltr">Objective</p><p dir="ltr"><a href="" target="_blank">We investigated the association between historic redlining and risk of </a>gestational diabetes (GDM), and if this relationship is mediated by maternal obesity and area-level deprivation.</p><p dir="ltr">Research design and methods</p><p dir="ltr">This retrospective study included 86,834 singleton pregnancies from Kaiser Permanente Southern California’s (KPSC) health records (2008–2018). <a href="" target="_blank">Redlining was assessed using digitized </a>Home Owners' Loan Corporation (HOLC) maps, with patient’s residential addresses geocoded and assigned HOLC grades (A,B,C,D) based on their geographic location within HOLC-graded zones. For GDM cases, exposure was assigned based on address at diagnosis date; for non-cases, it was assigned based on address during the 24th–28th gestational week. Health records were combined with area deprivation index (ADI) from 2011–2015 census data. Mixed-effect logistic regression models assessed associations between redlining and GDM, with mediation by BMI and ADI evaluated using inverse odds ratio weighting. <a href="" target="_blank">Models were adjusted for maternal age, education, race and ethnicity, neighborhood level income, and smoking status.</a></p><p dir="ltr">Results</p><p dir="ltr"><a href="" target="_blank">Among the 10,134 (11.67%) GDM cases</a>, we found increased risk of GDM in B ("Still desirable," adjusted odds ratio [aOR] 1.20, 95% confidence interval [CI] 0.99-1.44), C ("Definitely declining," aOR 1.22, 95% CI 1.02-1.47), and D ("Hazardous, i.e., redlined," aOR 1.30, 95% CI 1.08-1.57) graded neighborhoods compared to the "Best" graded zone. Pre-pregnancy BMI and ADI mediated 44.2%, and 64.5% of the increased GDM risk among mothers in redlined areas.</p><p dir="ltr">Conclusions</p><p dir="ltr"><a href="" target="_blank">Historic redlining is associated with an increased risk of GDM, mediated by maternal obesity and neighborhood deprivation. Future research is needed to explore the complex pathways linking redlining to pregnancy outcomes.</a></p>

  PublisherOA PDFDOI

• Mortality by Rurality Among Kidney Transplant Recipients in the United States over 20 Years

  Journal of the American Society of Nephrology · 2025-10-01

  article
  PublisherDOI

• Perceptions of anti-racism efforts and mental health among students in higher education in the United States

  Frontiers in Public Health · 2025-02-07 · 2 citations

  articleOpen accessSenior author

  Background: Anti-racism efforts are imperative for campus communities, yet little is known about whether perceiving their presence on campuses relates to a range of mental health outcomes among students. Methods: = 110,203). Using multivariable logistic regression, we examined the associations between perceptions of anti-racism efforts and several mental health outcomes. Results: Individuals who disagreed that their schools combatted racism in their campus communities had significantly greater odds of mental health problems (depression, anxiety, psychotic experiences, suicidal ideation, suicide plan, suicide attempt, perceived need for help, and loneliness), and lower odds of flourishing when compared with those who strongly agreed with the statement. For most outcomes, we observed an apparent dose-response association. Conclusion: Perceiving the presence of anti-racism efforts on campuses was inversely associated with mental health problems, calling for more research to test the effects of anti-racism efforts on mental health.

  PublisherOA PDFDOI

• Association of Historical Redlining with Gestational Diabetes Mellitus: The Mediating Role of Body Mass Index and Area Deprivation Index

  2025-02-12

  preprintOpen access

  <p dir="ltr">Objective</p><p dir="ltr"><a href="" target="_blank">We investigated the association between historic redlining and risk of </a>gestational diabetes (GDM), and if this relationship is mediated by maternal obesity and area-level deprivation.</p><p dir="ltr">Research design and methods</p><p dir="ltr">This retrospective study included 86,834 singleton pregnancies from Kaiser Permanente Southern California’s (KPSC) health records (2008–2018). <a href="" target="_blank">Redlining was assessed using digitized </a>Home Owners' Loan Corporation (HOLC) maps, with patient’s residential addresses geocoded and assigned HOLC grades (A,B,C,D) based on their geographic location within HOLC-graded zones. For GDM cases, exposure was assigned based on address at diagnosis date; for non-cases, it was assigned based on address during the 24th–28th gestational week. Health records were combined with area deprivation index (ADI) from 2011–2015 census data. Mixed-effect logistic regression models assessed associations between redlining and GDM, with mediation by BMI and ADI evaluated using inverse odds ratio weighting. <a href="" target="_blank">Models were adjusted for maternal age, education, race and ethnicity, neighborhood level income, and smoking status.</a></p><p dir="ltr">Results</p><p dir="ltr"><a href="" target="_blank">Among the 10,134 (11.67%) GDM cases</a>, we found increased risk of GDM in B ("Still desirable," adjusted odds ratio [aOR] 1.20, 95% confidence interval [CI] 0.99-1.44), C ("Definitely declining," aOR 1.22, 95% CI 1.02-1.47), and D ("Hazardous, i.e., redlined," aOR 1.30, 95% CI 1.08-1.57) graded neighborhoods compared to the "Best" graded zone. Pre-pregnancy BMI and ADI mediated 44.2%, and 64.5% of the increased GDM risk among mothers in redlined areas.</p><p dir="ltr">Conclusions</p><p dir="ltr"><a href="" target="_blank">Historic redlining is associated with an increased risk of GDM, mediated by maternal obesity and neighborhood deprivation. Future research is needed to explore the complex pathways linking redlining to pregnancy outcomes.</a></p>

  PublisherDOI

• Ethno-racial differences in anxiety and depression impairment among emerging adults in higher education

  SSM - Population Health · 2024-04-26 · 7 citations

  articleOpen access

  Background: Despite having higher exposure to stressors, many ethno-racial groups report similar or lower prevalence of clinical depression and anxiety compared to their White counterparts, despite experiencing greater psychosocial risk factors for poor mental health outcomes, thus presenting an epidemiological paradox. Ethno-racial differences in impairment, a diagnostic criterion, may in part explain this paradox. Methods: We analyzed data from the Healthy Minds Study (2020-2021) and using survey-weighted linear mixed effects models, we tested whether there were ethno-racial differences in impairment across multiple ethno-racial groups at various levels of severity for anxiety and depression. Results: Black students reported lower mean impairment scores relative to White students at moderate and severe anxiety. Hispanic/Latine students only reported lower impairment relative to White students at severe anxiety. Asian students reported relatively lower mean impairment than White students at mild anxiety, and this difference continued to grow as anxiety severity increased. Similar trends were observed for depression. Black and Hispanic/Latino students reported lower mean impairment scores at moderate to severe depression. Asian students reported lower mean impairment scores beginning at mild depression to severe depression. Conclusion: Self-reported anxiety and depression related impairment varies by ethno-racial group, with Black, Hispanic/Latinx, and Asian students reporting lower impairment compared to White students at higher levels of symptom severity. These findings open the possibility that racial differences in the impairment criterion of clinical diagnoses may explain some of the racial paradox.

  PublisherDOI

• Discrimination and sleep disturbance among older Black Americans: A longitudinal analysis of the Health and Retirement Study

  Sleep Health · 2024-10-10 · 4 citations

  articleOpen accessSenior author

  OBJECTIVES: Black and older adults have higher risk for sleep problems than their White and younger counterparts. Yet, our understanding of the determinants of sleep problems specifically among older Black adults is severely limited. The aim of this study was to determine whether everyday and major discrimination are longitudinally associated with sleep disturbance in a nationally representative sample of older Black adults. METHODS: Non-Latinx Black respondents aged 51+ were selected from waves 8 (2006) through 15 (2020) of the Health and Retirement Study (baseline N = 1397). Sleep disturbance was measured with the 4-item Jenkins Sleep Questionnaire. The 6-item Everyday Discrimination Scale was used to measure everyday discrimination, and the Major Experiences of Discrimination Scale was used to measure major discrimination. Analyses controlled for sociodemographics, health behaviors, and health conditions. Lagged mixed-effects linear regression models were performed to test the longitudinal associations between baseline discrimination and sleep disturbance over 12years. RESULTS: Higher baseline everyday discrimination was longitudinally associated with more severe sleep disturbance. Compared to respondents who reported no major discrimination at baseline, those who reported two or more major discrimination experiences had more severe sleep disturbance over time. CONCLUSIONS: This study provides critical information on the possible longitudinal drivers of sleep disparities at the population level. This information has implications for better understanding the mechanisms of health disparities and for attaining health equity.

  PublisherOA PDFDOI

Recent grants

• NIH Grant K01MH069923

  NIH · $731k · 2009

• NIH Grant R03AG018965

  NIH · $38k · 2002

• NIH Grant R01MH084963

  NIH · $824k · 2012

Frequent coauthors

• Robert Joseph Taylor

  University of Michigan–Ann Arbor

  48 shared

• Linda M. Chatters

  University of Michigan–Ann Arbor

  39 shared

• Ann W. Nguyen

  Case Western Reserve University

  24 shared

• David H. Chae

  Tulane University

  18 shared

• James S. Jackson

  University of Manchester

  14 shared

• María P. Aranda

  Hospital Son Llatzer

  7 shared

• Weidi Qin

  University of Wisconsin–Madison

  6 shared

• Uchechi A. Mitchell

  Chicago Department of Public Health

  5 shared

Education

• PhD, Social Work & Sociology

  University of Michigan

• BA, Sociology

  University of California Berkeley

• MSW, Social Work

  University of Michigan

• MA, Sociology

  University of Michigan

Awards & honors

• Fellow of the Gerontological Society of America
• Hartford Faculty Scholar
• Encore Public Voices Fellow
• Next Avenue Influencer in Aging
• Ranked third among the most influential African American soc…