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Rethinking Trends in Dementia Risk Disparities

Op-Med is a collection of original articles contributed by Doximity members.

Victor Ekuta is a 2020–2021 Doximity Research Review Fellow. Nothing in this article is intended nor implied to constitute professional medical advice or endorsement. The views expressed in this article are those of the author and do not necessarily reflect the views/position of Doximity. 

A growing body of research is exploring the relationship between racial inequities and dementia. Several studies report that dementia risk is twice as high among non-Hispanic Black Americans than among non-Hispanic white Americans. Yet few studies have evaluated whether there has been any progress in reducing dementia risk disparities among racial and ethnic minority populations at elevated risk.

A new study in JAMA Neurology sought to answer this question. Using the U.S. Health and Retirement Study, Powers et al. investigated trends in the incidence and prevalence of dementia and uncovered a striking finding — rates of dementia for Black Americans remained disproportionately high between 2000 and 2016, even as the rates of dementia for the U.S. population remained relatively stable or declined. Moreover, the investigators found no evidence that the relative Black-white disparities in incidence or prevalence were decreasing during this same period. 

While the large, diverse, nationally representative, and longitudinal nature of the study is compelling, there are weaknesses in the design that limit the results’ interpretation. For example, using algorithms to diagnose dementia in diverse populations has perils, and it is unclear the extent to which algorithmically defined dementia truly coincides with biomarker-based Alzheimer’s disease or other dementias. Similarly, racial/ethnic groups are not homogenous. The study does not account for heterogeneity or analyze other racial/ethnic groups, which impedes the conclusions drawn about the observed dementia risk disparities. 

Ultimately, the study provides convincing evidence of persistent race disparities in dementia and highlights an urgent need for new research approaches. If, as the authors posit, structural racism is at the root of these disparities, then we must evaluate whether current dementia research adequately accounts for the social determinants of brain health needed to understand dementia risk in African Americans. As the field of Alzheimer’s research continues to wrestle with fundamental questions about the cause of this terrible disease, perhaps now is the time to move beyond the rigid confines of individual-level risk factors, such as amyloid positivity, and embrace a group-level analysis of the social environment. Then, and only then, can we begin to do the important work of eliminating disparities.

Victor Ekuta is an MD candidate at UC San Diego School of Medicine. He has previously served as a TEDMED Research Scholar and a Doris Duke Clinical Research Fellow, among many others. In the future, he plans to specialize in academic neurology as a physician-scientist-advocate, employing novel approaches to treat human brain disease, combat health disparities, and boost diversity in STEM.

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