Increased Dementia Incidence among Black and Hispanic Veterans across Regions of the United States. (20th December 2022)

• Record Type: Journal Article
• Authors: Kornblith, Erica S; Bahorik, Amber L; Boscardin, W John; Xia, Feng; Barnes, Deborah E; Yaffe, Kristine
• Is Part Of: Alzheimer's & dementia. Volume 18(2022)Supplement 11
• Page Start: n/a
• Page End: n/a
• Publication Date: 2022-12-20
• Subjects: Alzheimer's disease -- Periodicals; Alzheimer Disease -- Periodicals; Dementia -- Periodicals; Démence; Maladie d'Alzheimer; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 616.83
• DOI: 10.1002/alz.062576
• Languages: English
• ISSNs: 1552-5260

Abstract

Abstract: Background: Although the US military is increasingly diverse, the association of race/ethnicity and geographical region with incidence of dementia diagnosis among older Veterans is unknown. Method: We identified a random sample of 1, 869, 090 patients age ≥ 55 years [mean age: 69.4 (standard deviation 7.9), 2% female] who received care at the Veterans Health Administration (VHA), the largest integrated health care system in the United States, between October 1, 1999 and September 30, 2019. Participants self‐reported race/ethnicity: White: 88.6% (n = 1, 655, 376); Black, 9.5% (n = 176, 795); Hispanic (1.0%, n = 20, 663), Asian (0.5%, n = 9, 391), or American Indian/Alaska Native [AIAN (0.4%, n = 6, 895). US region was derived using residential ZIP codes and categorized based on 10 Center for Disease Control and Prevention Health Promotion regions. Incident dementia was defined using International Classification of Diseases, 9 th (ICD‐9) and 10 th (ICD‐10) edition codes; age‐adjusted dementia incidence was estimated using direct standardization to compare rates by race/ethnicity overall and by US region. Result: Over a mean follow‐up of 10.1 years, 243, 272 (13%) participants received a diagnosis of dementia. Age‐adjusted incidence per 1, 000 person‐years was 14.2 [95% confidence interval (CI), 13.3‐15.1] for AIAN participants, 12.4 (95% CI, 11.7‐13.1) for Asian participants, 19.4 (95% CI, 19.2‐19.6) for Black participants, 20.7 (95% CI, 20.1‐21.3) for Hispanic participants, and 11.5 (95% CI, 11.4‐11.6) for White participants. Across US regions, a similar pattern was observed; compared to White participants, rates were significantly higher for Black participants across all regions (15.5 to 20.7, p values <0.001), and for Hispanic participants in all regions except the Southeast (14.0 to 21.7, p values ≤ 0.03). Across most regions, AIAN (8.6 to 16.2, ) and Asian participants (8.4 to 15.6, ) showed a pattern of rates that was similar to or slightly higher than for White participants (9.8 to 12.0, p values >0.05). Conclusion: Among older Veterans receiving care at VHA, where access to care for enrollees is held relatively equal, differences in dementia incidence were observed based on race/ethnicity. Across US regions, rates varied, but incidence was consistently higher for Black and Hispanic Veterans. Further research is needed to elucidate drivers of these differences.