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Prevalence of Dementia in American Indians and Alaska Natives Compared to White, Black, and Hispanic Medicare Beneficiaries: Findings from the National Health and Aging Trends Study

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Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

Objective

To estimate the prevalence of dementia among American Indian and Alaska Native (AIAN) Medicare beneficiaries and compare the prevalence of dementia in AIANs and other racial and ethnic minority groups—non-Hispanic Blacks (NHBs) and Hispanics—with non-Hispanic Whites (NHWs) Medicare beneficiaries.

Methods

We used survey data from Round 5 of the National Health and Aging Trends Study (NHATS, 2015) (N = 7,449), a nationally representative study of Medicare beneficiaries ages 65 years and older. We used logistic regression to estimate the age- and sex-adjusted prevalence of dementia with 95% confidence intervals by race/ethnicity as well as prevalence differences between groups.

Results

The majority of participants were between 65 and 74 years old. Approximately half of them were female. NHWs had a prevalence of 5% for dementia, and AIAIs had a prevalence of 9%, four percentage points higher than NHWs (95%CI 1%, 11%). We estimated a similar difference in the prevalence of dementia in AIAN Medicare beneficiaries compared to NHBs.

Conclusion

While previous research has reported that AIANs share a similar or lower prevalence of dementia than NHWs, our findings suggest a potentially higher prevalence of dementia among AIAN Medicare beneficiaries. A relatively small number of AIAN resulted in wide confidence intervals for many of our associations. Future research should focus on recruiting a larger sample and on dementia prevalence and unique risk factors within and among AIAN tribes.

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References

  1. Alzheimer’s Association. Alzheimer’s disease facts and figures. 2022. Available at: https://www.alz.org/media/documents/alzheimers-facts-and-figures.pdf. Accessed 03.02.2022.

  2. Langa KM, Larson EB, Crimmins EM, Faul JD, Levine DA, Kabeto MU, Weir DR. A comparison of the prevalence of dementia in the United States in 2000 and 2012. JAMA Intern Med. 2017;177(1):51–8.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Prince M, Bryce R, Albanese E, Wimo A, Ribeiro W, Ferri CP. The global prevalence of dementia: a systematic review and metaanalysis. Alzheimer’s Dementia. 2013;9(1):63-75. e62.

    Article  PubMed  Google Scholar 

  4. Garrett MD, Baldridge D, Benson W, et al. Mental health disorders among an invisible minority: depression and dementia among American Indian and Alaska Native elders. Gerontologist. 2015;55(2):227–36.

    Article  PubMed  Google Scholar 

  5. Vincent GK, Velkoff VA. The next four decades: the older population in the United States: 2010 to 2050. May 2010. Washington, DC: US Census Bureau. Available at: https://www.census.gov/prod/2010pubs/p25-1138.pdf. Accessed 03.02.2022.

  6. Administration on Aging, US Dept. of Health and Human Services. A profile of older Americans: 2016. Available at: https://www.giaging.org/documents/A_Profile_of_Older_Americans__2016.pdf. Accessed 03.02.2022.

  7. Indian Health Service. Fact sheets: disparities. October 2019. Retrieved from https://www.ihs.gov/newsroom/factsheets/disparities/. Accessed 03.02.2022.

  8. Sancar F, Abbasi J, Bucher K. Mortality among American Indians and Alaska Natives. JAMA. 2018;319(2):112–112.

    Article  PubMed  Google Scholar 

  9. Jervis LL, Manson SM. American Indians/Alaska Natives and dementia. Alzheimer Dis Assoc Disord. 2002;16:S89–95.

    Article  PubMed  Google Scholar 

  10. Mayeda ER, Glymour MM, Quesenberry CP, et al. Inequalities in dementia incidence between six racial and ethnic groups over 14 years. Alzheimers Dement. 2016;12(3):216–24.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Mehta KM, Yeo GW. Systematic review of dementia prevalence and incidence in United States race/ethnic populations. Alzheimers Dement. 2017;13(1):72–83.

    Article  PubMed  Google Scholar 

  12. Mehta KM, Yeo G. Incidence and prevalence of dementia in US race and ethnic populations. In: Yeo G, Gerdner LA, Gallagher-Thompson D, editors. Ethnicity and the Dementias. 3rd ed. New York, NY: Routledge; 2018. p. 3–20.

    Chapter  Google Scholar 

  13. Hall KS, Hendrie HC, Brittain HM, et al. The development of a dementia screening interview in two distinct languages. Int J Methods Psychiatr Res. 1993;3:1–28.

    Google Scholar 

  14. Hendrie HC, Hall KS, Pillay N, et al. Alzheimer’s disease is rare in Cree. Int Psychogeriatr. 1993;5:5–14.

    Article  CAS  PubMed  Google Scholar 

  15. Jervis LL, Manson SM. Cognitive impairment, psychiatric disorders, and problematic behaviors in a tribal nursing home. J Aging Health. 2007;19(2):260–74.

    Article  PubMed  Google Scholar 

  16. Mercer SO. Navajo elders in a reservation nursing home: health status profile. J Gerontol Soc Work. 1995;23(1–2):3–30.

    Article  Google Scholar 

  17. Rosenberg RN, Richter RW, Risser RC, et al. Genetic factors for the development of Alzheimer disease in the Cherokee Indian. Arch Neurol. 1996;53(10):997–1000.

    Article  CAS  PubMed  Google Scholar 

  18. Jervis LL, Cullum CM, Cox D, et al. Dementia assessment in American Indians. In: Yeo G, Gerdner LA, Gallagher-Thompson D, editors., et al., Ethnicity and the dementias. 3rd ed. New York, NY: Routledge; 2018. p. 108–23.

    Chapter  Google Scholar 

  19. Kasper JD, Freedman VA, Spillman BC. Classification of persons by dementia status in the National Health and Aging Trends Study. Technical Paper #5. July 2013. Baltimore: Johns Hopkins University School of Public Health. Available at: www.NHATS.org. Accessed 03.02.2022.

  20. Montaquila J, Freedman V, Spillman B, Kasper J. National Health and Aging Trends Study Development of Round 1 survey weights. NHATS Technical Paper #2. November 2012. Baltimore: Johns Hopkins University School of Public Health. Available at: www.NHATS.org. Accessed 03.02.2022.

  21. Freedman VA, Kasper JD. Cohort profile: the National Health and Aging Trends Study (NHATS). Int J Epidemiol. 2019;48(4):1044.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Galvin JE, Roe CM, Powlishta KK, et al. The AD8: A brief informant interview to detect dementia. Neurology. 2005;65(4):559–64.

    Article  CAS  PubMed  Google Scholar 

  23. Galvin JE, Roe CM, Xiong C, et al. Validity and reliability of the AD8 informant interview in dementia. Neurology. 2006;67(11):1942–8.

    Article  PubMed  Google Scholar 

  24. Galvin JE. Prevention of Alzheimer’s disease: lessons learned and applied. J Am Geriatr Soc. 2017;65(10):2128–33.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Muller CJ, MacLehose RF. Estimating predicted probabilities from logistic regression: different methods correspond to different target populations. Int J Epidemiol. 2014;43(3):962–70.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Rothman KJ, Greenland S, Lash TL. Modern epidemiology, vol. 3. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2008.

    Google Scholar 

  27. Wasserstein, Ronald L, Nicole A. Lazar. The ASA statement on p-values: context, process, and purpose. 2016;129–133.

  28. Amrhein V, Greenland S, McShane B. (2019) Scientists rise up against statistical significance.

  29. Mayeda, Elizabeth R et al. Racial/ethnic differences in dementia risk among older type 2 diabetic patients: the diabetes and aging study. Diab Care 37.4 (2014): 1009–1015.

  30. Cobb N, Espey D, King J. Health behaviors and risk factors among American Indians and Alaska Natives, 2000–2010. Am J Publ Health. 2014;104(S3):S481–9.

    Article  Google Scholar 

  31. Livingston G, Huntley J, Sommerlad A, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet. 2020;396(10248):413–46.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Scarmeas N, Albert SM, Manly JJ, Stern Y. Education and rates of cognitive decline in incident Alzheimer’s disease. J Neurol Neurosurg Psychiatry. 2006;77(3):308–16.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Garcia MA, Downer B, Chiu CT, et al. Racial/ethnic and nativity differences in cognitive life expectancies among older adults in the United States. Gerontologist. 2019;59(2):281–9.

    Article  PubMed  Google Scholar 

  34. Boccuti C, Swoope C, Artiga S. The role of Medicare and the Indian Health Service for American Indians and Alaska Natives: health, access and coverage. The Kaiser Family Foundation. December 18, 2014. Available at: https://www.kff.org/report-section/the-role-of-medicare-and-the-indian-health-service-for-american-indians-and-alaska-natives-health-access-and-coverage-report/. Accessed 03.02.2022.

  35. Moon H, Badana AN, Hwang SY, et al. Dementia prevalence in older adults: variation by race/ethnicity and immigrant status. Am J Geriatr Psychiatry. 2019;27(3):241–50.

    Article  PubMed  Google Scholar 

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Funding

Research reported in this publication was supported by the National Institute on Aging of the National Institutes of Health under Award Number P30AG059295.

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Authors and Affiliations

  1. Raymond A. Kent School of Social Work and Family Science, University of Louisville, Louisville, KY, USA

    Heehyul E. Moon & Sunshine M. Rote

  2. Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawaii at Mānoa, Honolulu, HI, USA

    Joseph Keaweʻaimoku Kaholokula

  3. School of Public Health, University of Minnesota, Minneapolis, MN, USA

    Richard F. MacLehose

Authors
  1. Heehyul E. Moon
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  2. Joseph Keaweʻaimoku Kaholokula
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  3. Richard F. MacLehose
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  4. Sunshine M. Rote
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Contributions

All authors contributed to the study conception and design. Material preparation, data preparation and analysis were performed Heehyul Moon, Joseph Keaweʻaimoku Kaholokula, Richard F. MacLehose, and Sunshine M. Rote. The first draft of the manuscript was written by Heehyul Moon and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Heehyul E. Moon.

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The current study was approved by the University of Louisville Institutional Review Board (20.111).

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The authors declare no competing interests.

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Moon, H.E., Kaholokula, J.K., MacLehose, R.F. et al. Prevalence of Dementia in American Indians and Alaska Natives Compared to White, Black, and Hispanic Medicare Beneficiaries: Findings from the National Health and Aging Trends Study. J. Racial and Ethnic Health Disparities 10, 1527–1532 (2023). https://doi.org/10.1007/s40615-022-01338-y

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  • DOI: https://doi.org/10.1007/s40615-022-01338-y

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