A recent report found deep social inequalities in U.S. counties with the highest Alzheimer’s rates among Blacks and Latinos.
Inequalities related to education, income, food insecurity, and the physical environment are collectively known as social determinants of health and are inextricably tied to location, according to the report from UsAgainstAlzheimer’s Center for Brain Health Equity and the Urban Institute, which compared counties with the highest Alzheimer’s rates among Blacks, Latinos, and non-Latino Whites to counties with the lowest rates among these populations.
Adopting a “place-based” approach to public health can decrease these risks by tailoring policies and targeting resources to where they will do the most good, the report’s authors said a recent webinar discussing their findings.
Understanding how location impacts Alzheimer’s is critical given the disorder’s growing burden on families, healthcare systems, and the economy. About 5.8 million people in the U.S. are currently living with Alzheimer’s or a related dementia. The authors’ previous research had projected that by 2030, an estimated 40% of the eight million Americans with Alzheimer’s or related dementias will be Latino or Black.
Counties with the highest Alzheimer’s rates in the report tended to have higher levels of poverty and less in terms of household income, access to exercise opportunities, and education compared to counties with the lowest rates.
“Median household incomes among Blacks are about 50% higher in those counties with the lowest prevalence of Alzheimer’s disease and just a little bit less so … for Latinos, whereas the difference for non-Latino Whites is much smaller,” said Stipica Mudrazija, PhD, senior research associate at the Urban Institute and the report’s lead author.
Education proved one of the greatest social determinants for Alzheimer’s risk. About 16% of adults have a bachelor’s degree in counties with the highest Alzheimer’s prevalence and related dementias among Blacks, and 19% in counties with the highest rates among Latinos, compared with 32% and 27%, respectively, in counties with the lowest prevalence in these populations.
“The reality is that brain development is impacted by the lack of education,” said William Vega, PhD, professor emeritus at the University of Southern California and another author of the report.
Education “has direct effects on the brain’s resilience and development over time and the ability to resist dementia — also the ability to manage dementia, in terms of progression,” he said.
These findings add to a growing body of evidence about the links between location and health. Research published recently in The Lancet, for instance, estimated that roughly 40% of worldwide dementias are related to social determinants such as education and diabetes, and are therefore preventable through public policy measures.
Based on their research, the authors make several recommendations on how best to adapt public health policy to address the social determinants of Alzheimer’s risk.
The recommendations include collecting data that more accurately describes individual communities and that links health to socioeconomic measures in order to focus resources on high-risk “hot spots.”
“We need to ensure that the data that we are looking at is informed with data about social determinants and that it is tailored to target solutions where they are needed the most,” said Stephanie Monroe, executive director of AfricanAmericansAgainstAlzheimer’s.
In pursuit of more inclusive data, the Center for Brain Health Equity is launching an initiative called the National Alzheimer’s Disease Index, to help analyze and visualize Medicare data in different locations and across different demographics.
Other recommendations include investing in national and community public health measures, investing in educational opportunities, incentivizing disparity reductions through insurance payment reform, and establishing workforce policies that promote economic opportunities and community resilience, among others.
“You have to ask the question, how much do we really expect to change our risk for dementia if we don’t deal with these fundamental determinants?” Vega said.
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