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. 2022;89(2):563-570.
doi: 10.3233/JAD-220278.

Importance of Accounting for Regional Differences in Modifiable Risk Factors for Alzheimer's Disease and Related Dementias: The Case for Tailored Interventions

Coles M Hoffmann  1 , Roch A Nianogo  2   3 , Kristine Yaffe  1   4   5   6 , Amy Rosenwohl-Mack  7 , Anna Carrasco  1 , Deborah E Barnes  1   5   6
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Importance of Accounting for Regional Differences in Modifiable Risk Factors for Alzheimer's Disease and Related Dementias: The Case for Tailored Interventions

Coles M Hoffmann et al. J Alzheimers Dis. 2022.

Abstract

Background: We recently estimated that 36.9% of Alzheimer's disease and related dementias (ADRD) cases in the US may be attributable to modifiable risk factors, but it is not known whether national estimates generalize to specific states or regions.

Objective: To compare national estimates of modifiable risk factors of ADRD to California, overall and by sex and race/ethnicity, and to estimate number of cases potentially preventable by reducing the prevalence of key risk factors by 25%.

Methods: Adults ≥18 years who participated in the Behavioral Risk Factor Surveillance Survey in California (n = 9,836) and the US (n = 378,615). We calculated population attributable risks (PARs) for eight risk factors (physical inactivity, current smoking, depression, low education, diabetes mellitus, midlife obesity, midlife hypertension, and hearing loss) and compared estimates in California and the U.S.

Results: In California, overall, 28.9% of ADRD cases were potentially attributable to the combination of risk factors, compared to 36.9% in the U.S. The top three risk factors were the same in California and the U.S., although their relative importance differed (low education [CA:14.9%; U.S.:11.7% ], midlife obesity [CA:14.9%; U.S.:17.7% ], and physical inactivity [CA:10.3%; U.S.:11.8% ]). The number of ADRD cases attributable to the combined risk factors was 199,246 in California and 2,287,683 in the U.S. If the combined risk factors were reduced by 25%, we could potentially prevent more than 40,000 cases in California and 445,000 cases in the U.S.

Conclusion: Our findings highlight the importance of examining risk factors of ADRD regionally, and within sex and race/ethnic groups to tailor dementia risk reduction strategies.

Keywords: Alzheimer’s disease; dementia; prevention; public health; risk factors.

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Conflict of interest statement

Authors’ disclosures available online (https://www.j-alz.com/manuscript-disclosures/22-0278r3).

Figures

Fig. 1
Fig. 1
Number of dementia cases prevented per 10,000 cases with 25% risk factor reduction.
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References

    1. Alzheimer’s Association (2019) 2019 Alzheimer’s disease facts and figures. Alzheimers Dementia 15, 321–387.
    1. Nianogo RA, Rosenwohl-Mack A, Yaffe K, Carrasco A, Hoffmann CM, Barnes DE (2021) Risk factors associated with Alzheimer Disease and related dementias by sex and race ethnicity in the US. JAMA Neurol 79, 584–591. - PMC - PubMed
    1. United States Census Bureau. California 2020 Census.
    1. CDC-BRFSS. Centers for Disease Control (CDC) - BRFSS. https://www.cdc.gov/brfss/index.html.
    1. Alzheimer’s Association. California’s State Plan for Alzheimer’s Disease: An Action Plan for 2011-2021. https://www.alz.org/national/documents/stateplan-calif.pdf. Accessed September 20, 2021.

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