Racial and Ethnic Disparities Among Individuals with Alzheimer’s Disease in the United States: A Literature Review

Abstract

This study reviews the published literature on racial and ethnic disparities among people with Alzheimer’s disease (AD) and related dementias in the United States. To identify relevant studies, we searched electronic sources for peer-reviewed journal articles and unpublished research reports that were published through July 2014; related to the AD population and their caregivers; and provided evidence of racial and ethnic disparities, discussed reasons for disparities, or described interventions to address disparities. The literature shows consistent and adverse disparities among blacks and Hispanics compared with non-Hispanic whites concerning AD, including the disease’s prevalence and incidence, mortality, participation in clinical trials, use of medications and other interventions, use of long-term services and supports, health care expenditures, quality of care, and caregiving. The literature suggests numerous underlying causes, including factors related to measurement of the disease, genetics, socioeconomic factors, cultural differences, lack of culturally competent clinicians, and discrimination. Although these disparities are well known, little is known about the effectiveness of various strategies, such as cultural competence training, to address these differences, and very few studies evaluate possible interventions.

Risk Factors Associated With Cognitive, Functional, and Behavioral Trajectories of Newly Diagnosed Dementia Patients

“…In our study, African Americans and whites have similar ages at the time of diagnosis, indicating African Americans may develop dementia at earlier ages. Others have noted that African Americans are more likely to be diagnosed later in the course of the disease and have a higher prevalence of dementia at all ages compared with whites (8,18). Our results contribute to the literature identifying disparities in dementia care and highlight the need for additional research on the mechanisms through which race affects dementia outcomes.…”

2020 Alzheimer's disease facts and figures

“…Despite some evidence that the influence of genetic risk factors on Alzheimer's and other dementias may differ by race, 80,82,245 genetic factors do not appear to account for the large differences in prevalence or incidence among racial groups 244,246 . Instead, health conditions such as cardiovascular disease and diabetes, which are associated with an increased risk for Alzheimer's and other dementias, are believed to account for these differences, as they are more prevalent in black/African American and Hispanic/Latino people 247,248 . Socioeconomic characteristics, including lower levels and quality of education, higher rates of poverty, and greater exposure to adversity and discrimination, may also increase risk in black/African American and Hispanic/Latino communities (and may in turn contribute to the health conditions mentioned above) 80,247‐249 .…”

“…244,246 Instead, health conditions such as cardiovascular disease and diabetes, which are associated with an increased risk for Alzheimer's and other dementias, are believed to account for these differences, as they are more prevalent in black/African American and Hispanic/Latino people. 247,248 Socioeconomic characteristics, including lower levels and quality of education, higher rates of poverty, and greater exposure to adversity and discrimination, may also increase risk in black/African American and Hispanic/Latino communities (and may in turn contribute to the health conditions mentioned above). 80,[247][248][249] Some studies suggest that differences based on race and ethnicity do not persist in rigorous analyses that account for such factors.…”

“…247,248 Socioeconomic characteristics, including lower levels and quality of education, higher rates of poverty, and greater exposure to adversity and discrimination, may also increase risk in black/African American and Hispanic/Latino communities (and may in turn contribute to the health conditions mentioned above). 80,[247][248][249] Some studies suggest that differences based on race and ethnicity do not persist in rigorous analyses that account for such factors. 135,187,244 There is evidence that missed diagnoses of Alzheimer's and other dementias are more common among older black/African Americans and Hispanics/Latinos than among older whites.…”

Inequalities in dementia incidence between six racial and ethnic groups over 14 years

“…It is widely believed there are racial/ethnic disparities in dementia incidence in the United States [3, 4], and social and behavioral factors are thought to be major drivers of these inequalities [5-8]. However, the currently available evidence is incomplete and difficult to interpret.…”