African Americans in Alameda County face twice the risk of Alzheimer’s and dementia-related diseases compared to non-Hispanic whites, according to recent county health department data.
On top of that, they have the county’s highest rates of emergency room visits and hospitalization due to these diseases.
The findings “bring up more questions than anything else for us,” said Roxanna Guide, an epidemiologist with the Alameda County Public Health Department.
Longer life expectancies in the United States mean more people are likely to be diagnosed with Alzheimer’s, a degenerative brain disease and the most common cause of dementia. In Alameda County, Alzheimer’s disease is now the third leading cause of death among older adults, behind heart disease and cancer. Between 2015 and 2017, the disease accounted for 14 percent of all deaths in the county. County health officials are now trying to figure out what racial disparities in the disease mean for their outreach and prevention efforts.
Kevin Matthews, a health geographer and lead author of a recent study about racial and ethnic estimates of Alzheimer’s in the U.S., said that rates of dementia are on the rise in part because “people are surviving other conditions.”
Today, Alzheimer’s disease affects 5.7 million people in the U.S., a figure that is expected to climb dramatically. A recent study published in Alzheimer’s & Dementia, a journal of the Alzheimer’s Association, estimated that by 2060, more than 16 million Americans will have Alzheimer’s.
And more than 3 million of them will be African American. That’s because the racial pattern of risk in Alameda County holds true across the country: Older African American adults have a higher risk of Alzheimer’s than any other group. In the U.S., nearly 15 percent of people with Alzheimer’s are African American, while just over 10 percent are non-Hispanic whites.
Health experts know many of the risk factors that can lead to Alzheimer’s: poor diets comprised of high-cholesterol and processed foods, inadequate physical activity, and other underlying, chronic health conditions.
But a different set of factors may be behind racial differences in the disease rates.
Some researchers, like the authors of a 2013 study published in the British Medical Journal, argue that poor access to health care services among African Americans can increase risk of the disease. Others, like the authors of a 2006 study published in the Journal of the American Geriatric Society, think that differences in educational quality between blacks and whites may contribute because educational differences also influence disease risk.
Still others say the real issue is that there is not enough clinical data on racial minorities.
Until recently, scientific studies on Alzheimer’s focused largely on non-Hispanic white patients. A study published in 2011 in the Journal of Cultural Diversity also found that there have been few opportunities for African Americans to participate in clinical trials and that researchers have done relatively little outreach to their communities.
“Historically, African Americans have not been actively recruited and encouraged to participate in research,” said Kevin Johnson, associate professor at UC Davis’ Alzheimer’s Disease Center.
When it comes to Alzheimer’s disease specifically, racial disparities in other areas may contribute to the problem. African Americans are 80 percent more likely than non-Hispanic whites to be diagnosed with diabetes, 40 percent more likely to have high blood pressure, and 30 percent more likely to die from heart disease. All three conditions are risk factors for Alzheimer’s.
And a 2017 study reported by researchers from the University of Wisconsin School of Medicine and Public Health in Madison found that African Americans also experience more stressful life events, such as financial insecurity and psychological or physical trauma, on top of chronic diseases. The study concluded that each stressful event aged the brain of African Americans by four years.
But Matthews said that public health improvements have had a positive effect. The Center for Disease Control and Prevention’s data shows the overall life expectancy gap between African Americans and non-Hispanic whites fell from 15 years in the early 1900s to 3.4 years in 2016.
“It is not that African Americans are not improving; they are just beginning to catch up,” he said.
Marion Brown, a gerontologist and social worker at the Alzheimer’s Services of the East Bay in Hayward, said that it is important for African Americans to know that early diagnosis can help delay memory loss symptoms and help caregivers plan ahead.
“There needs to be more information for families,” Brown said.
Matt Beyers, an epidemiologist and data analyst at the Alameda County Health Department, said that there has also been an increase in the number of hospitalizations and emergency department visits related to Alzheimer’s disease, but that nearly a hundred percent of the time, the patients are admitted for other complications, such as sepsis, urinary tract disorders or heart failure.
“Old age is all about battling chronic diseases,” Johnson said.
Alzheimer’s-related hospitalization rates, like Alzheimer’s rates, are at least twice as high among African Americans in Alameda County than other races. In Alameda County, Oakland’s Alta Bates Summit Hospital and Fremont’s Washington Hospital deal with the greatest number of these patients, according to health department data.
“It took a while for people to wake up and say, ‘Alzheimer’s is not a normal part of aging,’” Johnson said. “We believe it can be prevented and treated.”