Racial and Ethnic Disparities in Alzheimer's Disease

Alzheimer's disease affects all people. In fact, 5.8 million Americans are living with the disease. But there are differences in Alzheimer's between non-Hispanic whites, Hispanic/Latino people, and African Americans.¹

People of color get Alzheimer's more often

African Americans are 2 times more likely to develop Alzheimer's than whites. And Latinos are 1.5 times more likely than whites. Some of this has to do with other diseases that increase the risk of Alzheimer's, such as heart disease, stroke, high blood pressure, and diabetes. These conditions are more common in African Americans and Latinos than whites.²

Higher stress

Research shows that early childhood stress can age your brain and affect memory. African Americans experience 60 percent more stressful events than whites because of discrimination and inequality.³

Poor neighborhoods

The conditions in disadvantaged neighborhoods are linked with higher rates of Alzheimer's. One study found that African Americans born in these neighborhoods were 40 percent more likely to develop Alzheimer's than those born in safer neighborhoods.³

Doctors know that living in a disadvantaged neighborhood can affect health negatively. This is because people have trouble accessing healthy foods, safe exercise options, clean air and water, quality education, and good health care.³

People of color are diagnosed less often

Even though they get the disease more than whites, people of color are less likely to be diagnosed with Alzheimer's. There are a variety of reasons for this.

One recent study points to a genetic cause. African-Americans with Alzheimer's make less of the tau protein that is used to diagnose people with the disease. That means they may not get a positive test for Alzheimer's using the standard test. Other factors may include stigma, misunderstanding, and lack of access to high-quality healthcare.^2,4

Less participation in clinical trials

Fewer people of color join clinical trials, so their data is not included in the results. Several things impact clinical trial participation:⁵

• Whether the trials happen close by
• Whether childcare is offered
• Whether travel costs are reimbursed
• Language barriers
• Less awareness about clinical trials
• Less recruitment of minorities to join a clinical trial

Other differences by race

Chance of dying

Research shows that, on average, more whites die of Alzheimer's than African Americans. However, there are differences around the country. In the southern states that form the "stroke belt" (where more people suffer strokes than elsewhere in the US), blacks are more likely than whites to die of Alzheimer's. These states include Alabama, Arkansas, Georgia, Mississippi, North Carolina, South Carolina, and Tennessee.⁵

Impact of disease

Older African Americans with Alzheimer's consistently describe themselves as more impaired and needing more services than whites with similar symptoms. It is not clear if this is related to other health conditions that African-Americans may face, cultural differences, or other factors.⁵

Care and use of services

Other comparisons show that:⁵

• Whites tend to take more anti-dementia drugs than non-whites.
• People of color are 40 percent less likely to enter a long-term care facility than whites.
• Use of community social services does not differ by race.
• Attitudes toward end-of-life care are similar.

A few studies suggest that Medicare healthcare dollars are higher for people of color than for whites with Alzheimer's. In one study, African Americans' coverage was 45 percent higher than whites' Coverage for Hispanics was 37 percent higher.

Why are there differences?

The underlying reasons for the differences in who gets Alzheimer's are complex and connected. Important issues include:⁵

• Other health risks such as heart disease and diabetes
• Exposure to stress, including economic and social challenges
• Fewer chances for education
• Social factors that affect how people feel about memory loss and dementia
• Mistrust of the health care system
• Discrimination and racial bias
• Genetic factors that affect the disease and diagnosis