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Inequalities in dementia incidence between six racial and ethnic groups over 14 years
Open accessAbstract
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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“Its findings indicated that dementia incidence — determined by the first presence of a dementia diagnosis in members’ medical records — was highest among African American older adults (the term used in the study for those who self‐reported as Black or African‐American); intermediate for Latino older adults (the term used in the study for those who self‐reported as Latino or Hispanic), American”
From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [347]
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“Previous research indicates that NHB Americans have heightened risks of ADRDs relative to NHW Americans (Mayeda et al., 2016; Mehta & Yeo, 2017; Steenland et al., 2016; Yaffe et al., 2013).”
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“Similarly, the incidence of dementia was highest for Blacks, intermediate for Hispanics, American Indians, and Native Alaskans, and lowest for Asian Americans (Mayeda et al., 2016).”
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Alzheimer’s Disease Screening Tools for Asian Americans: A Scoping Review
Lim, S., Chong, S. K., Min, D., Mohaimin, S., Roberts, T. R., Trinh‐Shevrin, C., & Kwon, S. C. (2020) · Journal of Applied Gerontology · doi:10.1177/0733464820967594 · Cited by 9
Shippee, T. P., Parikh, R. R., Baker, Z. G., Bucy, T., Ng, W., Jarosek, S. L., Qin, X., Woodhouse, M., Nkimbeng, M. J., & McCarthy, T. C. (2023) · Journal of Aging and Health · doi:10.1177/08982643231191164 · Cited by 8
“…AD/ ADRD is highest among people who identify as African/ American/Black or American Indian/Alaska Native, but people who identify as Hispanic/Latino and/or Paci fi c Is-lander also experience high rates of AD/ADRD compared to Asian or White counterparts (Matthews et al., 2019; Mayeda et al., 2016).”
BackgroundRuthirakuhan, M. T., Alexander, M., Cogo‐Moreira, H., Robinson, T. L., Amariglio, R. E., Buckley, R. F., Sperling, R. A., Swardfager, W., Black, S. E., & Rabin, J. S. (2023) · The Journal of Prevention of Alzheimer s Disease · doi:10.14283/jpad.2023.98 · Cited by 8
Cothran, F. A., Alto, R., Farias, S. T., Johnson, D. K., Lara, E., Whitmer, R. A., DeCarli, C. S., & Meyer, O. L. (2021) · Alzheimer Disease & Associated Disorders · doi:10.1097/wad.0000000000000483 · Cited by 8
Self-citationStreitz, M. L., Denny, A., Xiong, C., McCue, L. M., Stites, S. D., Midgett, S., Mechanic-Hamilton, D. J., Moulder, K. L., Morris, J. C., & Balls‐Berry, J. E. (2022) · Alzheimer Disease & Associated Disorders · doi:10.1097/wad.0000000000000505 · Cited by 8
Huie, E. Z., Escudero, A., Saito, N. H., Harvey, D. J., Nguyen, M.-L., Lucot, K. L., LaGrande, J., Mungas, D., DeCarli, C. S., Lamar, M., et al. (2023) · Journal of Alzheimer s Disease · doi:10.3233/jad-220558 · Cited by 8
Tejera, C. H., Ware, E. B., Kobayashi, L. C., Fu, M., Hicken, M. T., Zawistowski, M., Mukherjee, B., & Bakulski, K. M. (2023) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2023.1052435 · Cited by 8
Promoting Growth in Behavioral Neurology: A Path Forward
Bateman, J. R., Josephy‐Hernandez, S. E., Apostolova, L. G., Benjamin, S., Barrett, A. M., Boeve, B. F., Budson, A. E., Chemali, Z. N., Lin, C.-Y. R., Daffner, K. R., et al. (2024) · Cognitive and Behavioral Neurology · doi:10.1097/wnn.0000000000000368 · Cited by 8
“…recognition of the facts that (a) disorders of cognition and comportment often disproportionately impact individuals from minority backgrounds (Mayeda et al., 2016), (b) structural and social determinants of health strongly in fl u-ence brain health, and (c) BNNP is an appealing sub-specialty…”
BackgroundTejera, C. H., Ware, E. B., Hicken, M. T., Kobayashi, L. C., Wang, H., Adkins‐Jackson, P. A., Blostein, F., Zawistowski, M., Mukherjee, B., & Bakulski, K. M. (2024) · Communications Medicine · doi:10.1038/s43856-024-00569-w · Cited by 11
Early-Life Parental Affection, Social Relationships in Adulthood, and Later-Life Cognitive Function
Thomas, P. A., Teas, E., Friedman, E. M., Barnes, L. L., Sauerteig-Rolston, M. R., & Ferraro, K. F. (2024) · Journal of Aging and Health · doi:10.1177/08982643241303589 · Cited by 9
“Additionally, given racial disparities in cognitive function and Alzheimer ’ s disease risk among older adults (Barnes & Bennett, 2014; D´ ı az-Venegas et al., 2016; Mayeda et al., 2016), we examined these direct and indirect pathways across racial groups.”
Ma, Y., Mora-Pinzon, M. C., Buckingham, W. R., Bersch, A. J., Powell, W. R., LeCaire, T. J., Ennis, G. E., Deming, Y. K., Jonaitis, E. M., Chin, N. A., et al. (2025) · Alzheimer s & Dementia Translational Research & Clinical Interventions · doi:10.1002/trc2.70036 · Cited by 8
“16,30 Moreover, the limited research does not capture the vast heterogeneity among their diverse subgroups in risks and pathology associated with genetic, cultural, socioeconomic, and immigration history differences.”
Sanborn, V. E., & Gunstad, J. (2020) · Geriatrics · doi:10.3390/geriatrics5040063 · Cited by 8
Gilsanz, P., Mayeda, E. R., Eng, C. W., Meyer, O. L., Glymour, M. M., Quesenberry, C. P., & Whitmer, R. A. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-040233 · Cited by 8
Self-citationRivera‐Hernandez, M., Kumar, A., Roy, I., Fashaw‐Walters, S. A., & Baldwin, J. A. (2021) · Journal of Aging and Health · doi:10.1177/08982643211043319 · Cited by 8
“Our study included Asians/Pacific Islanders and American Indians/Alaska Natives with ADRD, a group that has often been excluded, even though American Indian/Alaska Native residents may have higher incidence of dementia (Mayeda et al., 2016).”
BackgroundSunderaraman, P., Irani, F., Krishnan, K., & Hundal, J. S. (2021) · The Clinical Neuropsychologist · doi:10.1080/13854046.2021.1987524 · Cited by 8
“However, the primary Asian American subgroups in this study were Chinese, Japanese, and Filipinos (Mayeda et al., 2016) which limits understanding of dementia prevalence in Asian Indians.”
BackgroundWyman, M. F., Hulle, C. A. V., Umucu, E., Livingston, S., Lambrou, N. H., Carter, F. P., Johnson, S. C., Asthana, S., Gleason, C. E., & Zuelsdorff, M. L. (2022) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2022.924845 · Cited by 10
Quiñones, A. R., McAvay, G., Peak, K. D., Wyk, B. V., & Allore, H. G. (2022) · American Journal of Epidemiology · doi:10.1093/aje/kwac143 · Cited by 9
Casten, R. J., Leiby, B. E., Kelley, M., & Rovner, B. W. (2022) · Contemporary Clinical Trials · doi:10.1016/j.cct.2022.106977 · Cited by 9
Byrd, D. R., Gonzales, E. G., Moody, D. L. B., Marshall, G. L., Zahodne, L. B., Thorpe, R. J., & Whitfield, K. E. (2020) · Research in Human Development · doi:10.1080/15427609.2020.1746159 · Cited by 9
Petrosyan, D., Corrada, M. M., Kawas, C. H., Demoz, A., Ganzon, C., Popovich, O., Gaied, R., Mungas, D., Gilsanz, P., Vieira, K. E., et al. (2023) · Aging Clinical and Experimental Research · doi:10.1007/s40520-023-02368-0 · Cited by 8
“Studies of younger diverse populations suggest marked differences in rates of dementia by racial/ ethnic groups, with higher rates among Black and lower rates among Asian individuals [8], including those over age 90 [9].”
BackgroundSelf-citationKindratt, T. B., Zahodne, L. B., Dallo, F. J., & Ajrouch, K. J. (2024) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-024-02014-z · Cited by 7
Vidoni, E. D., Swinford, E., Barton, K., Perales‐Puchalt, J., Niedens, M., Lewandowski, T., Schwasinger-Schmidt, T. E., Peltzer, J. N., Wurth, J., Berkley‐Patton, J., et al. (2024) · Alzheimer s & Dementia Translational Research & Clinical Interventions · doi:10.1002/trc2.12475 · Cited by 7
“Although ADRD dispro-portionatelyimpactsolderadultsfromunder-resourced,marginalized, and minoritized communities, 4–6 these communities continue to be underrepresented in research settings.”
BackgroundChildhood Community Disadvantage and MRI-Derived Structural Brain Integrity After Age 65 Years
Peterson, R. L., Meza, E., George, K. M., Maillard, P., DeCarli, C. S., Gilsanz, P., Soh, Y., Lor, Y., Kind, A., Barnes, L. L., et al. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.43703 · Cited by 8
Self-citationImpact of racialization on neuroimaging and plasma biomarkers of Alzheimer's disease
Gogola, A., Zeng, X., Williams, L. A., Chapple‐McGruder, T., Saeed, A., Lopresti, B. J., Snitz, B. E., Tudorascu, D., Minhas, D. S., Ikonomović, M. D., et al. (2025) · Alzheimer s & Dementia · doi:10.1002/alz.70463 · Cited by 8
The Social Determinants of Health: Disparities in Cognitive Aging and Dementia
Barnes, L. L., & Zuelsdorff, M. L. (2025) · Annual Review of Developmental Psychology · doi:10.1146/annurev-devpsych-111323-101842 · Cited by 11
Quantifying diagnostic signal decay in dementia: a national study of Medicare hospitalization data
Spoto, F., Tian, J., Hügel, J., Ortega, D. T., Ritchie, C. S., Blacker, D., Dominici, F., Patel, C. J., Mork, D., & Estiri, H. (2025) · Alzheimer s & Dementia · doi:10.1002/alz.70945 · Cited by 7
“They are artifacts of a sociotechnical process shaped by institutional policies, provider incentives,EHRinterfaces,documentationculture,healthcaresystems dynamics, 9 access to care, and social context.”
A common 19 bp APOE enhancer deletion is protective against Alzheimer’s disease in African Americans
Brutman, J. N., Busald, T., Nizamis, E., Kaufman, E. J., Lin, E., Hendricks, N. E., Chintamen, S., Sulovari, A., Smukowski, S. N., Ye, Y., et al. (2026) · Nature Communications · doi:10.1038/s41467-026-68808-3 · Cited by 7
Unhealthy white matter connectivity, cognition, and racialization in older adults
Royse, S. K., Snitz, B. E., Hengenius, J. B., Huppert, T. J., Roush, R. E., Ehrenkranz, R. C., Wilson, J. D., Bertolet, M. H., Reese, A. C., Cisneros, G., et al. (2023) · Alzheimer s & Dementia · doi:10.1002/alz.13494 · Cited by 6
An EWAS of dementia biomarkers and their associations with age, African ancestry, and PTSD
Miller, M. W., Wolf, E. J., Zhao, X., Logue, M. W., & Hawn, S. E. (2024) · Clinical Epigenetics · doi:10.1186/s13148-024-01649-3 · Cited by 7
Rojas‐Saunero, L. P., Hughes, T. M., Mayeda, E. R., & Jimenez, M. P. (2024) · Alzheimer s & Dementia · doi:10.1002/alz.13894 · Cited by 5
Self-citationUse of the Montreal Cognitive Assessment (MoCA) in a Rural Outreach Program for Military Veterans.
Hilgeman, M. M., Boozer, E. M., Snow, A. L., Allen, R. S., & Davis, L. L. (2019) · PubMed · Cited by 7
A narrative review examining intersections of identity in older adult suicidality
Dautovich, N. D., MacPherson, A. R., Reid, M. P., & Stripling, A. M. (2020) · Aggression and Violent Behavior · doi:10.1016/j.avb.2020.101516 · Cited by 8
Discordance Between Subjective and Objective Cognitive Function in Older Korean Americans
Jang, Y., Choi, E. Y., Franco, Y., Park, N. S., Chiriboga, D. A., & Kim, M. T. (2021) · Journal of Aging and Health · doi:10.1177/0898264320988407 · Cited by 7
The Arabic Translation and Cross-Cultural Adaptation of the Bristol Activity of Daily Living Scale
Alkeridy, W. A., Khalifah, R. A. A., Mohammedin, A. S., Khallaf, R., Muayqil, T., & Bucks, R. S. (2022) · Journal of Alzheimer s Disease · doi:10.3233/jad-215489 · Cited by 7
Future Directions for the HRS Harmonized Cognitive Assessment Protocol
Torres, J. M., & Glymour, M. M. (2022) · Forum for Health Economics & Policy · doi:10.1515/fhep-2021-0064 · Cited by 8
Self-citationAssociation of Race and Ethnicity With Dementia
Yeo, G. W. (2022) · JAMA · doi:10.1001/jama.2022.4473 · Cited by 7
Racial and ethnic disparities in Alzheimer’s dementia
Lim, U., & Park, S. (2022) · Aging · doi:10.18632/aging.204421 · Cited by 7
Metadata
- 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.
- Venue
- Alzheimer's & Dementia
- Publisher
- Wiley
- Published
- 2016-02-10
- Volume
- 12
- Issue
- 3
- Pages
- 216-224
- ISSN
- 1552-5260 (ISSN-L)
- 1552-5279
- 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
- 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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