A systematic review/meta-analysis of prevalence and incidence rates illustrates systemic underrepresentation of individuals racialized as Asian and/or Asian-American in ADRD research

Abstract

We investigate Alzheimer's disease and related dementia (ADRD) prevalence, incidence rate, and risk factors in individuals racialized as Asian and/or Asian-American and assess sample representation. Prevalence, incidence rate, risk factors, and heterogeneity of samples were assessed. Random-effects meta-analysis was conducted, generating pooled estimates. Of 920 records across 14 databases, 45 studies were included. Individuals racialized as Asian and/or Asian-American were mainly from Eastern and Southern Asia, had higher education, and constituted a smaller sample relative to non-Hispanic white cohorts. The average prevalence was 10.9%, ranging from 0.4% to 46%. The average incidence rate was 20.03 (12.01-33.8) per 1000 person-years with a range of 75.19-13.59 (12.89-14.33). Risk factors included physiological, genetic, psychological, behavioral, and social factors. This review underscores the systemic underrepresentation of individuals racialized as Asian and/or Asian-American in ADRD research and the need for inclusive approaches accounting for culture, language, and immigration status. HIGHLIGHTS: There is considerable heterogeneity in the prevalence of ADRD among studies of Asian-Americans. There is limited data on group-specific risk factors for ADRD among Asian-Americans. The average prevalence of (ADRD) among Asian-Americans was found to be 7.4%, with a wide range from 0.5% to 46%.

Keywords: Alzheimer's disease and related dementia; asian; asian‐american; disparity; incidence; prevalence.

FIGURE 1

PRISMA flow diagram of studies screened and included in this systematic review.

FIGURE 2

The forest plot of the prevalence of Alzheimer's disease and related dementia among Asian participants. ^*The other six studies that are also based on the ADRD prevalence in White et al. (1996): Curb et al. (1999), Higuchi et al. (2015), Stewart et al. (2005), Launer et al. (2000), Stewart et al. (2007) and Gelber et al. (2012).

FIGURE 3

The forest plot of the incidence rate of Alzheimer's disease and related dementia among Asian participants. ^*The other five studies that are based on the similar incident rate reported in Mayeda et al. (2016): Hayes–Larson et al. (2023), Hayes–Larson et al. (2022), Mobley et al. (2023), Mayeda et al. (2017) and Mayeda et al. (2014). ^**The other 11 studies that are based on the similar incident rate reported in Havlik et al. (2000): Foley et al. (2001), Peila et al. (2004), Saczynski et al. (2006), Yucesoy et al. (2006), Laurin et al. (2007), Saczynski et al. (2007), Irie et al. (2008), Crane et al. (2009), de Jong et al. (2009), Kalmijn et al. (2000) and Gelber et al. (2011).