A new study from the Centers for Disease Control and Prevention (CDC) predicts explosive growth in the prevalence of Alzheimer’s disease and related dementias in Hispanic, African American, and other populations.
Researchers found that in 2014, 11.5% of 3.2 million Medicare fee-for-service beneficiaries had received a diagnosis of Alzheimer’s disease or related dementia (ADRD). They project the prevalence will increase 178% among all Americans aged 65 years and older by 2060, but Hispanic and other racial and ethnic groups will see the fastest growing rates.
The researchers are calling for a higher index of suspicion for early signs of ADRD among US minorities, as well as more screening and increased culturally competent care.
“Given the differences in the growth rates of different population subgroups in the United States, it is critical that culturally sensitive information be provided to obtain a diagnosis as early as possible and to improve the uptake of preventive health behaviors in all racial and ethnic subgroups in the United States,” write Kevin A. Matthews, of the Division of Population Health at the CDC’s National Center for Chronic Disease Prevention and Health Promotion, in Atlanta, Georgia, along with colleagues at the University of Wisconsin-Milwaukee and Morehouse School of Medicine.
The study was published online September 19 in Alzheimer’s and Dementia.
Although the primary risk factor for ADRD is age, race and ethnicity are also important demographic risk factors. Estimates of ADRD among these subgroups do not exist, the researchers note.
Therefore, Matthews and colleagues examined a nationally representative sample of more than 28 million Medicare fee-for-service beneficiaries in 2014. On the basis of ICD-9-CM codes, baseline data showed that the prevalence of ADRD was 13.3% among women and 9.2% among men. Not surprisingly, the rates increased with age, from 3.6% among those aged 65 to 74 years, to 13.6% among those aged 75 to 84 years, to 34.6% among those aged 85 and older.
This baseline snapshot also showed that estimated ADRD prevalence was highest among blacks, at 14.7%, followed by Hispanics, at 12.9%, non-Hispanic whites, at 11.3%, American Indian and Alaska Natives, at 10.5%, and Asian and Pacific Islanders, at 10.1%.
Matthews and colleagues predicted growth in ADRD prevalence among different segments of the overall American population (not just Medicare recipients). They used the estimate of nearly 5 million Americans aged 65 years and older who received an ADRD diagnosis in 2014 and extrapolated, using US Census Bureau data for population growth by race and ethnicity through 2060.
“We estimated 5.0 million adults aged ≥65 years with ADRD in the US population in 2014 and 13.9 million Americans aged ≥65 years with ADRD by 2060,” they write. “The burden of ADRD in 2014 was 1.6% of the US population in 2014 (n = 319 million), but this burden is expected to more than double to nearly 3.3% of the US population in 2060 (n = 417 million).”
The Hispanic population is expected to have the largest projected increase in ADRD cases over that time, the authors note, although, given the population size relative to other groups, the non-Hispanic white population will have the largest total number of cases in all years.
“As the United States becomes a majority-minority nation by 2050, increases in the number of non-Hispanic whites with ADRD will begin to plateau around 2030 while the number in minority populations will continue to grow, particularly among Hispanics,” they note.
Table. Estimated and Projected Prevalence of Alzheimer Disease and Related Dementias (in 1000s)
|Non-Hispanic White||3723 (10.3%)||4186||5638||7083||7365||7061|
|Asian and Pacific Islander||161 (8.4%)||212||356||554||761||999|
|American Indian and Alaska Native||27 (9.1%)||38||65||100||130||156|
|Two or more ethnicities on Census||43 (11.5%)||58||100||156||216||305|
|The 2014 figures do not include 23 people listed as “other or unknown.”|
“These findings support efforts to develop a culturally competent workforce of health-care providers of all types,” the researchers write. “Such training would help to improve the recognition of early signs of dementia despite cultural differences and to identify ways health-care workers can assist people with dementia in navigating the health-care system.”
Early diagnosis of ADRD could facilitate timely connections for patients and their caregivers, the researchers note. In addition, data that are more granular could help to identify subgroups with unique ADRD risks and needs.
Higher Clinical Suspicion Needed
“We have little knowledge about different ethnicities…. The data are not there, and new information is always good,” Douglas Scharre, MD, professor of clinical neurology and psychiatry at the Ohio State University Wexner Medical Center in Columbus, told Medscape Medical News when asked to comment.
There could be differences by race and ethnicity, the findings suggest, and “that could lead to better treatments,” he said. In addition, in terms of cultural competence, there may be better ways to evaluate people of different ethnicities.
The research raises big-picture issues for the entire aging US population as well. “We’re desperately behind in terms of primary care docs asking, screening, or investigating for cognitive impairment,” he said. He suggested screening at each Medicare well care visit for people aged 65 and older, for example.
“The importance of that, of course, is we know the earlier you identify and treat, even with our current medications, the better the course is,” he said.
The same message concerning regular screening and early identification holds true for neurologists. “If we know a certain ethnicity or genetic [group] is going to be prone to Alzheimer’s disease, we’re going to be looking for it earlier,” he added. “We’ll be looking more carefully because we’re more aware of it.”
The study authors and Dr Scharre have disclosed no relevant financial relationships.
Alzheimers Dement. Published online September 19, 2018. Full text