Advisory Council October 2016 Meeting Presentation: Racial/Ethnic Statistics and Demographics

10/31/2016

ADVISORY COUNCIL ON ALZHEIMER'S RESEARCH, CARE, AND SERVICES

Monday, October 31, 2016

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Prevalence and Incidence of Dementia in Race/Ethnic Populations in the U.S.

Gwen Yeo, PhD, AGSF

Systematic Review of Prevalence and Incidence of Dementia in US Race/Ethnic Populations

Mehta and Yeo

  • Search
    • 1229 studies reviewed
  • Data Base
    • 114 with appropriate recruitment and diagnostic methods included in data base
  • Analysis
    • Comparisons very difficult
    • Different ages, methodologies, reporting styles

What Do We Know About Dementia Prevalence in Race/Ethnic Populations?

African Americans

  • (10 of the 19 studies)
    • ~ ages of samples from 40+ to 100+
    • ~ prevalence ranges from 0.01% to 68%
    • ~ four reported age >65: 7%, 8%, 16%, 22%
    • ~ four reported age > 85: 18%, 23%, 32%, 59%

In the 8 studies who also had a non-Latino white comparison group, all but one showed lower rates for whites.

Latino/Hispanic Prevalence

  • Mexican American
    • SALSA > 60: 5%; >85: 31%
  • Puerto Rican (PR)
    • PR Veterans > 65: 13%
  • Cuban American (women)
    • > 65: 13%
  • Caribbean Hispanic (Dominican, PR, & Cuban)
    • 65-74: 8%
    • 75-84: 28%
    • > 85: 63% in those aged 85 and over.

Asian American Prevalence

  • Japanese Americans
    • Honolulu Heart Study/HAAS Men
      • > 65: 8%; >85: 33%
    • Kame Study (Seattle area)
      • > 65: 6%
    • Korean American MASK-MD
    • (screening data only) > 60: 7%

NO DATA AVAILABLE ON OTHER ASIAN AMERICAN POPULATIONS

American Indian Prevalence

NO RELIABLE REPORTS AMONG AMERICAN INDIAN POPULATIONS

Pacific Islander Prevalence

  • Chamorros (indigenous population of Guam)
    • > 65: 12% (9% Guam Dementia)

AVERAGE ANNUAL INCIDENCE BY RACE/ETHNICITY

Line chart.

What Did We Learn?

  • There are major gaps in the evidence for rates of prevalence or incidence among different race/ethnic populations.
    • American Indians
    • Most Asian American populations
      • Chinese, Filipino, Asian Indian, Vietnamese
      • Smaller Asian groups
    • Most Pacific Islander populations
  • It is impossible to compare results of studies fairly within or across population groups because of differences in:
    • Age of subjects
    • Recruitment and inclusion strategies
    • Diagnostic methods
    • How results are reported
      • By age categories only?
      • By gender categories only?

Result: Disparities cannot accurately be documented

  • It is important to disaggregate data on ethnic populations within the large race/ethnic categories used by OMB.
    • For example, the lowest and highest rates are found among populations classified as Hispanic/Latino. If lumped together, the results are misleading.

Northern CA Kaiser Permanente Multi-Ethnic Incidence Study, 2016

Followed 274 thousand patients >60 for 14 years, age adjusted dementia incidence rates per 1000 person/years were:

Asian American 15.2
NL White 19.4
Pacific Islander 19.6
Latino 19.6
American Indian/AN 22.2
African American 26.6
Mayeda et al.

Recommendations to Increase our Knowledge about Disparities

  • Develop standardized protocol for race/ethnic epidemiological research
  • Prioritize funding for ethnic specific populations with little or no data
  • Require inclusion of target community members in research team

Next Steps

  • Knowledge of Risk Factors
  • Interventions
  • Decrease in Disparities

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