‘Concerning trends’ in dementia mortality most notable among Black adults, women in US

Key takeaways:

• There was a significant increase in dementia-related deaths from 1999 to 2020.
• Black adults had the highest age-adjusted mortality rates due to factors such as health disparities and racial discrimination.

Mortality data from 1999 to 2020 revealed an upward trend in dementia-related mortality in the United States, especially among Black adults and women, according to a study published in The Primary Care Companion for CNS Disorders.

“There is a notable dearth of information regarding comparative mortality patterns from dementia among various demographic and regional groups in the United States,” Mohsan Ali, MBBS, of the department of psychiatry at King Edward Medical University in Lahore, Pakistan, and colleagues wrote.

Ali and colleagues conducted a retrospective cohort study to analyze contemporary trends in dementia and dementia-related mortality in the U.S. Their analysis included information from the CDC’s Wide-Ranging Online Data for Epidemiologic Research database, where dementia or Alzheimer’s disease was selected as a contributing or underlying cause of death. The researchers categorized annual age-adjusted mortality rates (AAMR) per 10,000 individuals by gender, racial and ethnic groups and geographic regions.

From 1999 to 2020, the researchers identified 6,601,680 dementia-related deaths. Of these deaths, 66.3% were among women and 85.5% among non-Hispanic white individuals.

Of the 6,584,630 deaths with available information, most occurred in nursing homes or long-term care facilities (55.3%), followed by the individuals’ homes (18%) and within medical facilities (16.3%).

The overall AAMR was 17.49, with a higher rate among women compared with men (18.19 vs. 16.05), according to the researchers.

“The higher prevalence of dementia among women can be primarily attributed to their longer lifespan, as age stands out as the most significant risk factor for AD, the most prevalent form of dementia,” Ali and colleagues wrote. “However, it’s worth noting that, regardless of age, women exhibit a higher risk of developing dementia compared to men.”

They also found that AAMR was higher among non-Hispanic Black adults (18.23) compared with non-Hispanic white (18.09) and Hispanic or Latino (12.7) adults.

“Genetic variants such as ABCA7 and APOE 4 have been attributed to a high risk of dementia in Black American adults,” the researchers wrote. “Nonetheless, numerous additional factors also play a role in this, including health disparities, socioeconomic status, limited health literacy, reduced access to quality education, family income, financial instability, chronic health conditions, stress and experiences of racial discrimination.”

During the study period, the AAMR increased from 10.86 to 21.42, with an annual percent change of 18.4% (95% CI, 4.7-31) from 1999 to 2001, according to the researchers. The AAMR remained relatively stable from 2001 to 2020, with an annual percent change of 1% (95% CI, 0.4-1.4).

Ali and colleagues also noted that nonmetropolitan areas had a higher increase in AAMR from 1999 (11.69) to 2020 (24.06) compared with urban areas, with states in the upper 90th percentile of dementia-related mortality exhibiting a higher burden of mortality compared with states in the bottom 10th percentile.

These “concerning trends” highlight “a critical need for targeted health care policy initiatives aimed at mitigating the increasing dementia burden,” the researchers wrote.

“These measures should prioritize prevention, early detection and the reduction of disparities in dementia care,” they added.

The researchers acknowledged several study limitations, including the use of ICD-CM codes and reliance on death certificates, which may have led to the misclassification of dementia as a cause of death in some instances.