Addressing Disparities in Alzheimer’s Disease

Did you know that Black and Latino adults are at much higher risk of Alzheimer’s disease and related dementias (ADRD) than White adults? And this disparity is expected to grow: CDC projects that cases of ADRD will increase seven-fold among Latino adults and four-fold among Black adults by 2060. In addition, Black and Latino adults with ADRD, along with those of other racial and ethnic minority groups, are more likely to face barriers to diagnosis, care, and services and are less likely to participate in ADRD-related research than White people.¹

Recent evidence suggests that the higher prevalence of ADRD among Black and Latino adults is related to higher rates of chronic health conditions and modifiable risk factors. Some of these modifiable risk factors for ADRD include depression, diabetes, hearing loss, mid-life hypertension, physical inactivity, poor diet quality and obesity, poor sleep quality and sleep disorders, tobacco use, traumatic brain injury, and excessive alcohol use. While ADRD cannot be prevented, we can work to reduce the risk of ADRD by addressing these modifiable risk factors and promoting healthy aging. Maintaining ideal blood pressure, quitting smoking, managing hearing loss, tracking and regulating blood sugar, and getting enough sleep can help improve brain health. And addressing inequities in these risk factors among historically marginalized populations and those disproportionately impacted is of critical importance in federal efforts to reduce disparities in the burden of ADRD.

A new CDC study examined the status of modifiable risk factors for ADRD among adults 45 years and older and found that high blood pressure and not meeting the aerobic physical activity guideline² were the most common, each affecting nearly 50% of adults. The prevalence of several modifiable risk factors, such as obesity and diabetes, was higher among Black and Latino populations than in other races and ethnicities. Adults with subjective cognitive decline (SCD), an early indicator of possible future ADRD, were more likely to report four or more risk factors than were those without SCD (34.3% versus 13.1%). The prevalence of SCD increased from 3.9% among adults with no risk factors to 25.0% among those with four or more risk factors.

CDC, ASPE, and our federal partners recently celebrated the 10^th Anniversary of the National Plan to Address Alzheimer’s Disease, which has galvanized federal agencies and stakeholders to accelerate efforts to prevent and treat ADRD. Addressing inequities has always been a cornerstone of the National Plan and the authorizing National Alzheimer’s Project Act legislation. As we look into the future, we are energized to focus our efforts on the recently added 6^th goal of the National Plan – Accelerate Action to Promote Healthy Aging and Reduce Risk Factors for ADRD. This goal is key to our National Center for Chronic Disease Prevention and Health Promotion’s strategies at CDC. And with President Biden’s Executive Order on Advancing Racial Equity and Support for Underserved Communities Through the Federal Government, federal agencies have intensified their commitment to addressing these inequities.

Here are just a few examples of how CDC is driving this work:

• CDC’s National Healthy Brain Initiative (NHBI) has expanded and created partnerships, enhanced data collection and reporting, increased awareness of brain health, and supported implementation of our Road Map series: State and Local Public Health Partnerships to Address Dementia: The 2018–2023 Road Map and the Healthy Brain Initiative Road Map for Indian Country. NHBI activities are expected to promote brain health, address cognitive impairment including ADRD, and support the needs of caregivers. One NHBI grantee, UsAgainstAlzheimers, has partnered with minority-serving organizations like Latino Nurses Network, LatinaStrong Foundation, and Diverse Alzheimer’s. Together they are developing and sharing culturally tailored resources for Black and Latino adults on topics such as ADRD, brain health, health disparities, and social determinants of health (SDOH).
• CDC is implementing the Building Our Largest Dementia (BOLD) Infrastructure for Alzheimer’s Act through our ADRD Public Health Centers of Excellence, which provide technical assistance to public health departments across the country in implementing effective interventions. These interventions prioritize early detection and diagnosis, reducing risk factors, preventing avoidable hospitalizations, and reducing health disparities. Interventions also focus on supporting the needs of caregivers and supporting care planning for people living with the disease.
• CDC’s BOLD Public Health Center of Excellence on Dementia Risk Reduction assists public health entities as they address the risk factors for cognitive decline. The Center emphasizes that health equity is intertwined with SDOH. There are systemic factors that lead to health disparities in both risk factors and cognitive decline. The Center is creating a plan to help public health address SDOH related to dementia risk factors while ensuring that stakeholders representing diverse communities are participating in Community Convenings. The Center is elevating the incorporation of health equity and SDOH in community-developed actions.

CDC is just one of many federal partners working to meet the tenets of the National Plan, particularly that of reducing ADRD disparities among racial and ethnic minorities. We are working hard to meet these needs through our internal work and our external supports. To get a clearer picture of current work and gaps that still need to be addressed, ASPE released an issue brief and inventory of Federal Efforts to Address Racial and Ethnic Disparities in ADRD. Progress has been made in the past 10 years. This anniversary marks a time to build on that momentum and boost our efforts to address ADRD in all communities.

References

1. 2021 Alzheimer’s disease facts and figures. Alzheimers Dement. 2021 Mar;17(3):327-406. doi: 10.1002/alz.12328.
2. Adults are recommended to do at least 150 minutes to 300 minutes (5 hours) a week of moderate-intensity, or 75 minutes (1 hour and 15 minutes) to 150 minutes (2 hours and 30 minutes) a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity. https://health.gov/our-work/nutrition-physical-activity/physical-activity-guidelines/current-guidelines