Cited by 885Dementia and Cognitive Impairment ResearchHealth disparities and outcomesAlzheimer's disease research and treatments

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

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Mayeda, Elizabeth Rose, Glymour, M.Maria, Quesenberry, Charles P., Whitmer, Rachel A.·2016·Alzheimer's & Dementia

DOI 10.1016/j.jalz.2015.12.007PMC PMC4969071

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Abstract

Introduction: Reducing racial/ethnic disparities is a primary objective of the National Alzheimer's Plan (NAPA), yet direct comparisons within large samples representing diversity of the United States are lacking. Methods: Dementia incidence from January 1, 2000 to December 31, 2013 and a 25‐year cumulative risk in 274,283 health care members aged 64+ (n = 18,778 African‐American, n = 4543 American Indian/Alaska Native [AIAN], n = 21,000 Latino, n = 440 Pacific Islander, n = 206,490 white, n = 23,032 Asian‐Americans). Cox proportional hazard models were adjusted for age, sex, medical utilization, and comorbidities. Results: Dementia incidence (n = 59,555) was highest for African‐Americans (26.6/1000 person‐years) and AIANs (22.2/1000 person‐years); intermediate for Latinos (19.6/1000 person‐years), Pacific Islanders (19.6/1000 person‐years), and whites (19.3/1000 person‐years) and lowest among Asian‐Americans (15.2/1000 person‐years). Risk was 65% greater for African‐Americans (hazard ratio = 1.65; 95% confidence interval = 1.58–1.72) versus Asian‐Americans. Cumulative 25‐year risk at age 65 was as follows: 38% African‐Americans, 35% AIANs, 32% Latino, 25% Pacific Islanders, 30% white, and 28% Asian‐Americans. Discussion: Dementia rates varied over 60% between groups, providing a comprehensive benchmark for the NAPA goal of reducing disparities.

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Background
Birth in High Infant Mortality States and Dementia Risk in a Cohort of Elderly African American and White Health Care Members
Gilsanz, P., Mayeda, E. R., Glymour, M. M., Quesenberry, C. P., Mungas, D., DeCarli, C. S., & Whitmer, R. A. (2018) · Alzheimer Disease & Associated Disorders · doi:10.1097/wad.0000000000000270 · Cited by 16
Self-citation
BrainWorks: A Comparative Effectiveness Trial to Examine Alzheimer's Disease Education for Community-Dwelling African Americans
Lincoln, K. D., Chow, T. W., & Gaines, B. F. (2018) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2018.09.010 · Cited by 18
Differences in survival and mortality in minority ethnic groups with dementia: A systematic review and meta-analysis
Co, M., Couch, E., Gao, Q., Martinez, A., Das‐Munshi, J., & Prina, M. (2021) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.5590 · Cited by 15
Analysis of eligibility criteria in Alzheimer’s and related dementias clinical trials
Mitchell, A. K., Ehrenkranz, R. C., Franzen, S., Han, S. H., Shakur, M., McGowan, M., & Massett, H. A. (2024) · Scientific Reports · doi:10.1038/s41598-024-65767-x · Cited by 17
“This is especially salient for AD/ADRD trials, as overly stringent criteria are particularly likely to exclude participants from historically underrepresented groups who may experience higher rates of dementia-related risk factors 2,4,7,13,14 .”
Background
Stroke Belt birth state and late-life cognition in the Study of Healthy Aging in African Americans (STAR)
George, K. M., Peterson, R. L., Gilsanz, P., Barnes, L. L., Mayeda, E. R., Glymour, M. M., Mungas, D., DeCarli, C. S., & Whitmer, R. A. (2021) · Annals of Epidemiology · doi:10.1016/j.annepidem.2021.09.001 · Cited by 16
Self-citation
Observational studies in Alzheimer disease: bridging preclinical studies and clinical trials
Brenowitz, W. D., & Yaffe, K. S. (2022) · Nature Reviews Neurology · doi:10.1038/s41582-022-00733-7 · Cited by 16
Advancing Aging Research Through a Health Disparities Perspective
Camargo, J. T., Smith, J. T., Rodriquez, E. J., & Pérez‐Stable, E. J. (2024) · The Journals of Gerontology Series A · doi:10.1093/gerona/glae082 · Cited by 15
Classification of Mild Cognitive Impairment and Alzheimer’s Disease Using Manual Motor Measures
Koppelmans, V., Ruitenberg, M. F. L., Schaefer, S. Y., King, J. B., Jacobo, J. M., Silvester, B., Mejia, A. F., van der Geest, J. N., Hoffman, J. M., Taşdizen, T., et al. (2024) · Neurodegenerative Diseases · doi:10.1159/000539800 · Cited by 15
The Prevalence of Mild Cognitive Impairment in a Convenience Sample of 202 Gulf War Veterans
Chao, L. L. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17197158 · Cited by 16
Relationships Between Enriching Early-Life Experiences and Cognitive Function Later in Life Are Mediated by Educational Attainment
Morris, T. P., Ai, M., Chaddock‐Heyman, L., McAuley, E., Hillman, C. H., & Kramer, A. F. (2021) · Journal of Cognitive Enhancement · doi:10.1007/s41465-021-00208-5 · Cited by 17
The Role of Dementia Diagnostic Delay in the Inverse Cancer–Dementia Association
Hayes‐Larson, E., Shaw, C. L., Ackley, S. F., Zimmerman, S. C., Glymour, M. M., Graff, R. E., Witte, J. S., Kobayashi, L. C., & Mayeda, E. R. (2021) · The Journals of Gerontology Series A · doi:10.1093/gerona/glab341 · Cited by 13
Self-citation
Effects of Lifestyle Factors on Cognition in Minority Population of Older Adults: A Review
EUBANK, J. M., Oberlin, D. J., Alto, A., Sahyoun, N. R., Asongwed, E. T., Monroe-Lord, L., & Harrison, E. A. (2022) · Frontiers in Nutrition · doi:10.3389/fnut.2022.841070 · Cited by 17
Pathways explaining racial/ethnic disparities in incident all‐cause dementia among middle‐aged US adults
Weiss, J., Beydoun, M. A., Beydoun, H. A., Kuczmarski, M. F., Banerjee, S. K., Hamrah, A., Evans, M. K., & Zonderman, A. B. (2023) · Alzheimer s & Dementia · doi:10.1002/alz.12976 · Cited by 16
Perceived threat of Alzheimer’s disease and related dementias among older Chinese Americans in subsidized housing: Through a cultural lens
Shi, Y., Sun, F., Liu, Y., & Marsiglia, F. F. (2018) · Dementia · doi:10.1177/1471301218805901 · Cited by 16
The Potential of ‘Omics to Link Lipid Metabolism and Genetic and Comorbidity Risk Factors of Alzheimer’s Disease in African Americans
Stepler, K. E., & Robinson, R. A. S. (2019) · Advances in experimental medicine and biology · doi:10.1007/978-3-030-05542-4_1 · Cited by 15
Ethnic disparity in access to the memory assessment service between South Asian and white British older adults in the United Kingdom: A cohort study
Ogliari, G., Turner, Z., Khalique, J., Gordon, A. L., Gladman, J. R. F., & Chadborn, N. (2020) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.5263 · Cited by 15
Is Tamsulosin Linked to Dementia in the Elderly?
Frankel, J., Duan, Y., & Albertsen, P. C. (2018) · Current Urology Reports · doi:10.1007/s11934-018-0821-0 · Cited by 14
Overcoming the COVID-19 Pandemic for Dementia Research: Engaging Rural, Older, Racially and Ethnically Diverse Church Attendees in Remote Recruitment, Intervention and Assessment
Wiese, L. K., Williams, I. C., Schoenberg, N. E., Galvin, J. E., & Lingler, J. H. (2021) · Gerontology and Geriatric Medicine · doi:10.1177/23337214211058919 · Cited by 14
“African Americans and Hispanics have higher ADRD risks than Whites (Amjad et al., 2018; Mayeda et al., 2016), and rural residents face higher risks than urban dwellers (Matthews et al., 2019).”
Background
Association of Race and Income with Incident Diagnosis of Alzheimer’s Disease and Related Dementias among Black and White Older Adults
Keohane, L. M., Nikpay, S., Braun, K., Cheng, A. K., Stevenson, D. G., Buntin, M. B., Yu, D., Blot, W. J., & Lipworth, L. P. (2022) · Journal of Applied Gerontology · doi:10.1177/07334648221142851 · Cited by 14
Understanding Barriers and Facilitators to Signing Up for a Mobile-Responsive Registry to Recruit Healthy Volunteers and Members of Underrepresented Communities for Alzheimer's Disease Prevention Studies
Neffa-Creech, D., Aggarwal, R., Stowell, C., Menon, U., George, S., Plant, A., & Langbaum, J. B. S. (2023) · The Journal of Prevention of Alzheimer s Disease · doi:10.14283/jpad.2023.67 · Cited by 14
Socioeconomic Status Disparities in Cognitive and Physical Functional Impairment among Older Adults: Comparison of Asians with other Major Racial/Ethnic Groups
Wang, K. W., Zhu, Z., & Qi, X. (2023) · Journal of Urban Health · doi:10.1007/s11524-023-00768-1 · Cited by 14
Racial, ethnic, and rural disparities in distance to physicians among decedents with Alzheimer's disease and related dementias in Washington State
Amiri, S., Keffeler, J. I., Crain, D. R., Denney, J. T., & Buchwald, D. (2024) · Alzheimer s & Dementia · doi:10.1002/alz.13756 · Cited by 14
Promoting diversity in clinical trials: insights from planning the ALUMNI AD study in historically underrepresented US populations with early symptomatic Alzheimer's disease
Wise-Brown, A., Brangman, S. A., Henderson, J. N., Willis‐Parker, M., Monroe, S., Mintzer, J. E., Grundman, M., Smith, J., Doody, R. S., Lin, H. H., et al. (2024) · EClinicalMedicine · doi:10.1016/j.eclinm.2024.102693 · Cited by 14
Ethnic differences in the prevalence of amyloid positivity and cognitive trajectories
Jang, H., Chun, M. Y., Yun, J., Kim, J. P., Kang, S. H., Weiner, M. W., Kim, H. J., Na, D. L., Hong, C., Son, S. J., et al. (2024) · Alzheimer s & Dementia · doi:10.1002/alz.14247 · Cited by 15
Apolipoprotein E genotype and in vivo amyloid burden in middle-aged Hispanics
Palta, P., Rippon, B., Reitz, C., He, H., Sherwood, G., Ceballos, F., Teresi, J. A., Razlighi, Q. R., Moreno, H., Brickman, A. M., et al. (2020) · Neurology · doi:10.1212/wnl.0000000000010707 · Cited by 14
“Additional studies are needed to examine whether ethnic differences in social determinants of health and biomarkers of AD neuropathology explain documented race-ethnicity differences.(29)”
Background
Cardiometabolic Conditions and All-Cause Dementia Among American Indian and Alaska Native People
Goins, R. T., Winchester, B., Jiang, L., Grau, L., Reid, M., Corrada, M. M., Manson, S. M., & O’Connell, J. (2021) · The Journals of Gerontology Series A · doi:10.1093/gerona/glab097 · Cited by 14
“These studies’ results showed that AI/ANs had the second highest dementia incidence (5) and the second shortest median survival among all race and ethnic groups aged 60 years and older (6).”
Result
Rural stakeholder perceptions about cognitive screening
Wiese, L. K., Galvin, J. E., & Williams, C. L. (2018) · Aging & Mental Health · doi:10.1080/13607863.2018.1525607 · Cited by 15
“…navigating a limited health care system, low health literacy, and insufficient access to primary and specialty providers (Abner et al., 2016; Dubois, Padovani, Scheltens, Rossi, & Dell’Agnello, 2016; Lines et al., 2014; Mayeda et al., 2016; Sayegh & Knight, 2013; Wiese, Williams, & Tappen, 2014).”
Background
Race, Genetic Admixture, and Cognitive Performance in the Cuban Population
Llibre‐Guerra, J. J., Li, Y., Allen, I. E., Llíbre-Guerra, J. C., Salgado, A. M. R., Peñalver, A. I., Almirall‐Sánchez, A., Yokoyama, J. S., Grinberg, L. T., Valcour, V., et al. (2021) · The Journals of Gerontology Series A · doi:10.1093/gerona/glab063 · Cited by 14
Offspring Study of Racial and Ethnic Disparities in Alzheimer’s Disease: Objectives and DesignPreprint
Manly, J. J., Rentería, M. A., Avila‐Rieger, J. F., Turney, I. C., Vonk, J. M. J., Lao, P. J., Šeblová, D., Fleurimont, J., Martinez, M. N., & Brickman, A. M. (2020) · PsyArXiv (OSF Preprints) · doi:10.31234/osf.io/frbkj · Cited by 13
Measures of Adiposity and Alzheimer’s Disease-Related MRI Markers: The Northern Manhattan Study
Caunca, M. R., Simonetto, M., Alperin, N. J., Elkind, M. S. V., Sacco, R. L., Wright, C. B., & Rundek, T. (2019) · Journal of Alzheimer s Disease · doi:10.3233/jad-190092 · Cited by 13
“However, these data come from a cohort of Australian participants, and thus results may not be generalizable to minority populations in the United States at higher risk for dementia [9].”
Cultural factors related to neuropsychological performance and brain atrophy among Hispanic older adults with amnestic Mild Cognitive Impairment (aMCI): A pilot study
Rodriguez, M. J., Mendoza, L., Rodríguez, I. G., Rosselli, M., Loewenstein, D., Burke, S. L., Orozco, A., & Duara, R. (2020) · Applied Neuropsychology Adult · doi:10.1080/23279095.2020.1761368 · Cited by 15
“More recently, it has been predicted that the prevalence of dementia for Hispanics/Latinos over the age of 65 in the next 25 years will be about 32% (Mayeda et al., 2016).”
Background
Changes in prevalence of cognitive impairment and associated risk factors 2000–2015 in São Paulo, Brazil
Ribeiro, F. S., Duarte, Y. A. D. O., Santos, J. L. F., & Leist, A. K. (2021) · BMC Geriatrics · doi:10.1186/s12877-021-02542-x · Cited by 15
“Thus, differences in education, health, socioeconomic background, cultural factors [26, 27], and structural discrimination might explain a higher prevalence of dementia for blacks [28].”
Background
The Effects of Midlife Acute and Chronic Stressors on Black–White Differences in Cognitive Decline
Mitchell, U. A., Shaw, B. A., Torres, J. M., Brown, L. L., & Barnes, L. L. (2023) · The Journals of Gerontology Series B · doi:10.1093/geronb/gbad143 · Cited by 13
Ethnic background and distribution of clinical phenotypes in patients with probable progressive supranuclear palsy
Couto, B., Luca, D. G. D., Antwi, J., Bhakta, P., Fox, S. H., Tartaglia, M. C., Kovács, G. G., & Lang, A. E. (2024) · Parkinsonism & Related Disorders · doi:10.1016/j.parkreldis.2024.106955 · Cited by 13
Racial and Ethnic Disparities in the Monetary Value of Informal Caregiving for Non-Institutionalized People Living With Dementia
Cantu, P. A., Cho, T., Wyman, M. F., McFall, B. H., & Ajrouch, K. J. (2024) · Journal of Aging and Health · doi:10.1177/08982643241262917 · Cited by 14
“…Alzheimer ’ s disease in the United States (Alzheimer ’ s Association, 2022), and dementia prevalence is higher in racial and ethnic minoritized groups than in the non-Hispanic White (henceforth White) population (Manly et al., 2022; Mayeda et al., 2016; Rajan et al., 2021; Zhang et al., 2016).”
Are Family Caregiving Programs Appropriate for Minority Caregivers? A Systematic Review of 37 Caregiving Programs
Meinertz, N., Lee, J., & Kim, Y. (2024) · Journal of Applied Gerontology · doi:10.1177/07334648241298109 · Cited by 13
“…prevalence of dementia is higher among Black/African American and Hispanic adults compared to White adults; these minority groups are more likely to receive delayed dementia diagnosis and are less likely to receive dementia care after the diagnosis (Chen & Zissimopoulos, 2018; Mayeda et al., 2016).”
Introducing social determinants of health to the Alzheimer's Disease Research Center network: Development and implementation in the Uniform Data Set
Zuelsdorff, M. L., Abner, E. L., Balls‐Berry, J. E., Jicha, G. A., Lanata, S., Maestre, G. E., Rosselli, M., Stites, S. D., Whitmer, R. A., Wilkins, C. H., et al. (2025) · Alzheimer s & Dementia · doi:10.1002/alz.70279 · Cited by 13
Self-citation
Contribution of socioeconomic, lifestyle, and medical risk factors to disparities in dementia and mortality
Weiss, J. (2021) · SSM - Population Health · doi:10.1016/j.ssmph.2021.100979 · Cited by 15
“Investigators have also reported higher incidence rates of dementia among racial/ethnic minority groups, with non-Hispanic black adults having the highest incidence followed by Hispanic adults and non-Hispanic whites (Mayeda et al., 2016; Shadlen, Larson, Gibbons, McCormick, & Teri, 1999; Yaffe et al., 2013).”
Background
The Living Alone with Cognitive Impairment Project’s Policy Advisory Group on Long-Term Services and Supports: Setting a Research Equity Agenda
Portacolone, E., Torres, J. M., Johnson, J. K., Benton, D. M., Rapp, T., Tran, T., Martinez, P., & Graham, C. L. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19106021 · Cited by 13
Disparate Dementia Risk Factors Are Associated with Cognitive Impairment and Rates of Decline in African Americans
Lachner, C., Craver, E. C., Babulal, G. M., Lucas, J. A., Ferman, T. J., White, R. O., Graff‐Radford, N. R., & Day, G. S. (2023) · Annals of Neurology · doi:10.1002/ana.26847 · Cited by 12
Histories of neighborhood socioeconomic status contribute to race differences in later‐life cognition
Sol, K., Morris, E. P., Lee, J. H., Zaheed, A. B., Palms, J. D., Scambray, K. A., Clarke, P. J., & Zahodne, L. B. (2024) · Alzheimer s & Dementia · doi:10.1002/alz.13786 · Cited by 12
Community recruitment of underrepresented populations to the AHEAD 3‐45 preclinical AD trial using novel partnerships with nursing and community‐based organizations: Lessons and outcomes
Salazar, C. R., Tallakson, M. B., Corona, M. G., Duran, E., Russ, E., Hoang, D. K., Romero, R. A., Sultzer, D. L., Grill, J. D., & Shin, H. (2024) · Alzheimer s & Dementia · doi:10.1002/alz.14211 · Cited by 12
“16,17 Limited available evidence on dementia incidence among Asian American communities suggests they have a lower dementia risk than White American individuals, 18,19 and incidence varies across subgroups.”
Diagnosing Alzheimer Disease
Day, G. S. (2024) · CONTINUUM Lifelong Learning in Neurology · doi:10.1212/con.0000000000001507 · Cited by 12
Childhood adversity and late‐life cognitive and brain health in a diverse cohort
Hayes‐Larson, E., Gradwohl, N. M., Fong, J., Kobayashi, L. C., Gilsanz, P., Whitmer, R. A., Glymour, M. M., Barnes, L. L., Koenen, K. C., DeCarli, C. S., et al. (2024) · Alzheimer s & Dementia · doi:10.1002/alz.14388 · Cited by 12
Self-citation
High rates of undiagnosed vascular cognitive impairment among American Indian veterans
Kirkpatrick, A. C., Stoner, J. A., Donna-Ferreira, F. M., Malatinszky, G. C., Guthery, L. D., Scott, J., & Prodan, C. I. (2019) · GeroScience · doi:10.1007/s11357-019-00055-5 · Cited by 12
Family type and cognitive function in older Chinese Americans: acculturation as a moderator
Li, M., Lu, S., Hoover, D. R., Flynn, L. T., Silverstein, M. D., Wu, B., & Dong, X. (2021) · Aging & Mental Health · doi:10.1080/13607863.2021.1926426 · Cited by 16

Authors: Mayeda, E. R., Glymour, M. M., Quesenberry, C. P., & Whitmer, R. A.
Affiliations: University of California, San Francisco (US)
Kaiser Permanente (US)
Corresponding author: Whitmer, Rachel A.
ORCID: Mayeda, Elizabeth Rose
Glymour, M.Maria
Quesenberry, Charles P.
Whitmer, Rachel A.
Venue: Alzheimer's & Dementia
Publisher: Wiley
Published: 2016-02-10
Volume: 12
Issue: 3
Pages: 216-224
ISSN: 1552-5260 (ISSN-L)
1552-5279
DOI: 10.1016/j.jalz.2015.12.007
PMC: PMC4969071
OpenAlex: W2266863819
Cited by: 883
References: 51
Citations by year: 2026: 98 · 2025: 109 · 2024: 112 · 2023: 113 · 2022: 113 · 2021: 100 · 2020: 96 · 2019: 66 · 2018: 41 · 2017: 27 · 2016: 7
FWCI: 41.77
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Alzheimer s & Dementia (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
eScholarship (California Digital Library) (submittedVersion)
Funders: National Institute on Aging
National Institutes of Health
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
Social Sciences › Health › Health disparities and outcomes
Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Alzheimer's disease research and treatments
Keywords: dementia incidence, racial and ethnic disparities
MeSH terms: Age Factors, Aged, Aged, 80 and over, Black or African American, Delivery of Health Care, Dementia, Ethnicity, Female, Hispanic or Latino, Humans, Indians, North American, Longitudinal Studies, Male, Middle Aged, Sex Factors, Socioeconomic Factors, United States, Incidence, Proportional Hazards Models, White People

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

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