Cross-racial study of 1.87m vets shows wide disparities in dementia
Date:
April 19, 2022
Source:
University of California - San Francisco
Summary:
In what is believed to be the largest study to date on race and
dementia, researchers tracked health and demographic data from close
to two million veterans. It compared rates of dementia across five
racial groups and showed significant race-based variations in the
incidence of the condition.
FULL STORY ==========================================================================
In what is believed to be the largest study to date on race and dementia, researchers from UCSF and the San Francisco Veterans Affairs Health
Care System tracked health and demographic data from close to two
million veterans. It compared rates of dementia across five racial
groups and showed significant race-based variations in the incidence of
the condition.
==========================================================================
This study is also believed to be the first to report the rate of dementia
in Native Americans using a nationwide sample, the researchers stated
in their paper, publishing in JAMA on April 19, 2022.
Of the 1.87 million veterans, whose average age was 69, 88.6% were white,
9.5% were Black, 1% Hispanic, 0.5% Asian and 0.4% Native American. Just
2.3% were female, consistent with the gender distribution of the older
veteran population. All received their health care at medical centers
of the Veterans Health Administration (VHA) located throughout the
continental United States.
Among the 13% of participants who were diagnosed with dementia over
the course of the 10-year study, the researchers found that rates were
markedly higher for Hispanic and Black veterans than they were for whites:
99% and 55% respectively. These results reinforce previous research that
showed elevated rates for both groups.
Rates for Asian veterans have not been as widely documented and in this
study were 24% higher than for whites. Among Native Americans, the rate
was 8% higher than for whites, a finding that enhances prior research
that has focused on smaller, geographically limited populations and has
shown conflicting results, according to the researchers.
When adjusting for sex, education, and underlying medical and psychiatric conditions, differences in dementia rates for all four groups were
narrowed slightly in relation to whites: 92% higher for Hispanics, 54%
for Blacks, 20% for Asians and 5% for Native Americans. This finding
for Native Americans shows no significant difference with whites, the researchers noted.
========================================================================== Senior author Kristine Yaffe, MD, of the UCSF Departments of Psychiatry
and Behavioral Sciences, Neurology, Epidemiology and the San Francisco
Veterans Affairs Health Care System, said she had been surprised by
the relatively low risk for Native Americans. "There may be genetic
or resilience factors that we just don't know about yet," she said,
"or maybe even a survival bias. Those who are old enough to get dementia
may have a survival advantage." Vets at Higher Risk for Dementia, Due
to TBI, PTSD, Poor Cardiovascular Health Yaffe said the study was unique
in that it evaluated racial differences among five groups, versus two
or three in previous studies, and that the cohort received their health
care at the VHA, the largest integrated care system in the United States.
"U.S. veterans are at high risk of dementia because of exposure
to military- related risk factors, like traumatic brain injury and post-traumatic stress disorder, and high prevalence of cardiovascular
and other non-military risk factors," she said.
As expected, health and education disparities associated with dementia
were more apparent in some groups. Native Americans were least likely to
live in zip codes where more than 25% of residents were college-educated (26.9%), and had the highest rate of obesity (16.4%), post-traumatic
stress disorder (11.2%) and alcohol use disorder (9.1%). Hispanics had
the highest rate of diabetes (36.1%) and stroke (8.2%), and Blacks had
the highest rate of hypertension (73.7%).
==========================================================================
The researchers found regional variations in dementia incidence, but Black
and Hispanic veterans were consistently identified as having higher risk
than the other groups.
These racial and ethnic differences are concerning, said first author
Erica Kornblith, PhD, of the UCSF Department of Psychiatry and Behavioral Sciences, and the San Francisco Veterans Affairs Health Care System,
"but they underscore the need to explore the cause of these differences
with the ultimate goal of ameliorating them." Differences in Dementia Diagnosis May Reflect Biases of Doctors Differences in dementia diagnosis
may also reflect "the biases of doctors who make the diagnosis or biases
in our cognitive tests, as well as the impact of education, and medical
and psychiatric variables," Kornblith said.
Since most veterans serve as young adults and remain eligible for health
care for the rest of their lives, it is likely that the participants
had more equitable access than that of the general population, the
researchers noted.
"This implies other mechanisms may be at play, such as early life circumstances, or that there were differences in quality of health care, despite better access," said Yaffe, who is also affiliated with the UCSF
Weill Institute for Neurosciences and the Northern California Institute
for Research and Education. "In future studies, we hope to have a better understanding of the mechanisms that are driving the differences in
dementia incidence across these five groups," she said.
Funding: This study was supported by Department of Veterans Affairs Rehabilitation Research and Development Career Development Award (CDA-2)
1 IK2 RX003073-01A2 (Kornblith) and NIA grant K24 AG031155, R35 AG071916 (Yaffe).
========================================================================== Story Source: Materials provided by
University_of_California_-_San_Francisco. Original written by Suzanne
Leigh. Note: Content may be edited for style and length.
========================================================================== Journal Reference:
1. Erica Kornblith, Amber Bahorik, W. John Boscardin, Feng Xia,
Deborah E.
Barnes, Kristine Yaffe. Association of Race and Ethnicity With
Incidence of Dementia Among Older Adults. JAMA, 2022; 327 (15):
1488 DOI: 10.1001/ jama.2022.3550 ==========================================================================
Link to news story:
https://www.sciencedaily.com/releases/2022/04/220419112419.htm
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