Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Aug 1;35(8):745-751.
doi: 10.1093/ajh/hpac063.

Vulnerability to Hypertension Is a Major Determinant of Racial Disparities in Alzheimer's Disease Risk

Igor Akushevich  1 , Stanislav Kolpakov  1 , Arseniy P Yashkin  1 , Julia Kravchenko  2
Affiliations

Vulnerability to Hypertension Is a Major Determinant of Racial Disparities in Alzheimer's Disease Risk

Igor Akushevich et al. Am J Hypertens. .

Abstract

Background: Higher incidence levels of Alzheimer's disease (AD) in Black Americans are well documented. However, quantitative explanations of this disparity in terms of risk-factor diseases acting through well-defined pathways are lacking.

Methods: We applied a Blinder-Oaxaca-based algorithm modified for censored data to a 5% random sample of Medicare beneficiaries age 65+ to explain Black/White disparities in AD risk in terms of differences in exposure and vulnerability to morbidity profiles based on 10 major AD-risk-related diseases.

Results: The primary contribution to racial disparities in AD risk comes from morbidity profiles that included hypertension with about 1/5th of their contribution due to differences in prevalence (exposure effect) and 4/5ths to differences in the effects of the morbidity profile on AD risk (vulnerability effect). In total, disease-related effects explained a higher proportion of AD incidence in Black Americans than in their White counterparts.

Conclusions: Disease-related causes may represent some of the most straightforward targets for targeted interventions aimed at the reduction of racial disparities in health among US older adults. Hypertension is a manageable and potentially preventable condition responsible for the majority of the Black/White differences in AD risk, making mitigation of the role of this disease in engendering higher AD incidence in Black Americans a prominent concern.

Keywords: Alzheimer’s disease; Medicare; blood pressure; hypertension; older adults; racial disparity.

PubMed Disclaimer

Figures

Graphical Abstract
Graphical Abstract
Figure 1.
Figure 1.
Age-specific incidence of Alzheimer’s disease. Age-specific incidence per 100,000 (dots) and associated 95% confidence intervals (bars) for African Americans (blue dots/bars) and White Americans (red dots/bars).
Figure 2.
Figure 2.
Age-specific effects of all other factors in the Oaxaca-Blinder models. The age-specific intercept terms for Black (blue) and White (red) Americans represent the effects of all other factors not included in the model at each age-group. Estimates based on models with disease indicators (small dots) and morbidity profiles (small squares) are shown. Large dots show the logarithm of observed age-specific incidence shown in Figure 1.
See this image and copyright information in PMC

Comment in

References

    1. 2021 Alzheimer’s disease facts and figures. Alzheimers Dement 2021; 17:327–406. - PubMed
    1. Mayeda ER, Glymour MM, Quesenberry CP, Whitmer RA. Inequalities in dementia incidence between six racial and ethnic groups over 14 years. Alzheimers Dement 2016; 12:216–224. - PMC - PubMed
    1. Matthews KA, Xu W, Gaglioti AH, Holt JB, Croft JB, Mack D, McGuire LC. Racial and ethnic estimates of Alzheimer’s disease and related dementias in the United States (2015–2060) in adults aged ≥65 years. Alzheimers Dement 2019; 15:17–24. - PMC - PubMed
    1. Silva MVF, Loures CMG, Alves LCV, de Souza LC, Borges KBG, das Graças Carvalho M. Alzheimer’s disease: risk factors and potentially protective measures. J Biomed Sci 2019; 26:1–11. - PMC - PubMed
    1. Clark LR, Koscik RL, Allison SL, Berman SE, Norton D, Carlsson CM, Betthauser TJ, Bendlin BB, Christian BT, Chin NA. Hypertension and obesity moderate the relationship between β-amyloid and cognitive decline in midlife. Alzheimers Dement 2019; 15:418–428. - PMC - PubMed

Publication types