Achieving Health Equity in Alzheimer's and Dementia

Overview

The conditions in which people are born, grow, work, live, and age are known as social determinants of health (SDOH). They are the underlying social, economic, policy, and other nonmedical factors that influence health.

These conditions can:

• Systematically limit opportunities for members of some groups to be healthy.
• Have a major impact on a person’s health, including their risk for Alzheimer's disease and related dementias (ADRD).

More work needs to be done to determine the exact relationship between these factors and dementia. But there is growing research around the social and economic factors that contribute to a person's health status, including their risk for dementia. These factors, as well as public health solutions to address disparities in ADRD, are explored below.

Who is affected

Alzheimer's disease is the most common form of dementia. 1

A recent study suggests that the number of people with clinical Alzheimer's disease is expected to increase from about 6.9 million people in 2024 to about 14 million people in 2060.1

• The largest increases are expected among people from racial/ethnic minority groups.1
• Cases among Hispanic adults are expected to increase 4 times, from 870,000 in 2024 to 3.7 million in 2060.1
• Cases among Black adults are expected to more than double, from 1.3 million in 2024 to 3.1 million in 2060.1

There are a number of factors that may account for the increased risk of Alzheimer's disease among these groups, when compared to White populations:

• Higher prevalence of conditions like heart disease and diabetes, which are risk factors for dementia.
• Lower levels of education.
• Higher rates of poverty.
• Greater exposure to adversity and discrimination.

Sex differences

Significantly more women than men have Alzheimer's disease.1 This is primarily because women typically live longer than men.

The disparity between women and men is expected to widen in the coming decades.

Between 2020 and 2060:

• The number of both women and men with Alzheimer's disease is expected to more than double.
• The number of women with Alzheimer's disease is expected to increase from 3.7 million to 8.2 million.
• The number of men with Alzheimer's disease is expected to increase from 2.3 million to 5.6 million.

Disparities in ADRD care and research

Unequal access to quality care

Experiences in ADRD care and support services can be different depending on race, ethnicity, geography, and social and economic factors.

For example, factors in health care settings that can contribute to disparities in ADRD care include:

• Cultural differences between providers and persons with ADRD, leading to communication problems.
• Negative social attitudes toward patients from other races or ethnicities.

Community factors that can contribute to health care disparities in some racial and ethnic groups include:

• Limited community awareness and understanding of ADRD.
• Barriers to accessing high-quality health care.
• Challenges getting a proper diagnosis and effectively managing the disease.

Unequal treatment of racial/ethnic minority caregivers

Caregivers are an important part of the care and support team for people with ADRD. Yet an Alzheimer's Association report of caregivers from racial and ethnic minority groups showed that:2

• Half or more of caregivers said they faced discrimination when navigating health care settings for their care recipient.2
• Caregivers' top concern was that providers or staff did not listen to what they were saying because of their race or ethnicity.

Unequal representation in ADRD research

These disparities go beyond the medical care provided to patients with ADRD and their caregivers. They include unequal representation of Black, Hispanic, Asian, and American Indian or Alaska Native persons in clinical trials for Alzheimer's disease.

• This may limit the knowledge we have and affect the care these individuals receive.

Reducing health disparities

Public health response

Understanding the disparities in ADRD is the first step toward developing and implementing strategies and services for those most at risk for developing the disease.

There is still much work to be done to address health and health care disparities in ADRD care3. Public health agencies can address this problem by helping:

• Prepare the workforce to care for a racially and ethnically diverse older adult population.
• Increase diversity among providers for dementia care.
• Engage, recruit, and retain diverse populations in ADRD research and clinical trials.
• Enhance access to health care services.
• Improve the environments where we live, learn, work, and play.

Resources