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. 2021 Aug;69(8):2306-2315.
doi: 10.1111/jgs.17215. Epub 2021 May 19.

Geographic disparities in mortality from Alzheimer's disease and related dementias

Igor Akushevich  1 , Arseniy P Yashkin  1 , Anatoliy I Yashin  1 , Julia Kravchenko  2
Affiliations

Geographic disparities in mortality from Alzheimer's disease and related dementias

Igor Akushevich et al. J Am Geriatr Soc. 2021 Aug.

Abstract

Objectives: The regions with highest and lowest Alzheimer's disease (AD) mortality across the United States at state/county levels were identified and their contribution to the differences in total mortality rates between these regions was evaluated. The disease, disease group, sex, race/ethnicity, and place-of-death-related inter-region differences that engender the disparity in mortality were quantitatively described. The hypothesis that inter-regional differences in filling out death certificates are a major contributor to differences in AD mortality was tested.

Design: Retrospective evaluation of death certificate data.

Setting: The United States.

Participants: Deceased US residents, 1999-2018.

Methods: Region-specific age-adjusted mortality rates and group-specific rate decomposition.

Results: The county clusters with the highest and lowest AD mortality rates were in Washington (WA) and New York (NY), respectively, with other notable high-mortality clusters on the border of Tennessee, Georgia, and Alabama as well as in North Dakota and South Dakota. These patterns were stable over the 1999-2018 period. AD had the highest contribution to total mortality difference between WA and NY (156%, higher in WA), in contrast circulatory diseases had a contribution of comparable magnitude (154%) but were higher in NY. Differences in cause-of-death certificate coding, either through coding of non-AD dementias, or other conditions accompanying a potential AD death could not account for differences in AD mortality between NY and WA.

Conclusions: Inter-regional differences in filling out death certificates were not a major contributor to variation in AD mortality between the regions with the highest and lowest rates. The respective mitigation of the effects of neural and circulatory diseases and several other high-impact conditions would not negate the disparity in mortality between NY and WA.

Keywords: Alzheimer's disease; cause of death; disparities; mortality.

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Conflict of interest statement

Conflict of Interest:

The authors have no conflicts of interest to report.

Figures

Figure 1.
Figure 1.. Total Age-Adjusted Death Rate from Alzheimer’s Disease Averaged Over the 1999–2018 Period
None
Figure 2.
Figure 2.. Comparison of the Logarithms of the Mortality Rates in New York and Washington Using 1-year and 10-year Age Groups
Logarithms of All-cause mortality (NY: circle-filled; WA: circle), Diseases of the circulatory system (NY: triangle-filled; WA: triangle), Diseases of the nervous system (NY: square-filled; WA: square).
See this image and copyright information in PMC

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