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A new study by the Centers for Disease Control and Prevention (CDC) predicts an explosive growth in the prevalence of Alzheimer's disease and related dementias among Hispanic, African American and other populations.
The researchers found that in 2014, 11.5% of the 3.2 million beneficiaries at the Medicare Act had been diagnosed with Alzheimer's disease or related dementia. They predict that the prevalence will increase by 178% among all Americans aged 65 and over by 2060, but Hispanic and other racial and ethnic groups will experience the fastest growth.
Researchers are asking for a higher index of suspicion for early signs of the disease among American minority members, as well as more culturally competent screening and care.
"Given the differences in growth rates of the different population subgroups in the United States, it is essential to provide culturally sensitive information for diagnosis as early as possible and to improve preventive behaviors in all subpopulations. racial and ethnic groups in the United States, "write Kevin A. Matthews of the Population Health Division of the CDC's National Center for Chronic Disease Prevention and Health Promotion in Atlanta, Georgia, with colleagues from Wisconsin-Milwaukee and the Morehouse School of Medicine.
The study was published online September 19 Alzheimer's and dementia.
Although age, race, and ethnicity are the main risk factors for the disease, important demographic risk factors are also important. The researchers note that estimates of SARD among these subgroups do not exist.
As a result, Matthews and colleagues examined a nationally representative sample of more than 28 million Medicare beneficiaries in 2014. Based on the ICD-9-CM codes, baseline data showed that the prevalence of the disease was 13.3%. 9.2% in men. Unsurprisingly, rates increased with age, rising from 3.6% among those aged 65 to 74 to 13.6% among those aged 75 to 84, to 34.6% among those aged 85 and over.
This baseline snapshot also showed that ADRD prevalence was highest among blacks (14.7%), followed by Hispanics (12.9%), non-Hispanic whites (11.3%) America and Alaska (10.5%). at 10.1%.
Matthews and his colleagues predicted a growth in the prevalence of SARD among different segments of the American population in general (not just the beneficiaries of Medicare). They used the estimate of nearly 5 million Americans aged 65 and over who were diagnosed with ADRD in 2014 and were extrapolated, using US Census Bureau data for population growth and ethnic until 2060.
"We estimated 5.0 million adults aged 65 or older with the disease in US patients in 2014 and 13.9 million Americans aged 65 or older with the disease in 2060" , they write. "The burden of disease in 2014 was 1.6% of the US population in 2014 (n = 319 million), but this burden is expected to more than double to reach nearly 3.3% of the US population in 2060 (n = 417 million). "
The Hispanic population is expected to experience the largest projected increase in DRAD cases during this period, although, given the size of the population compared to other groups, the non-Hispanic white population will have the highest number of cases.
"As the United States becomes a majority nation in 2050, the increase in the number of non-Hispanic whites with ADRD will begin to stabilize by 2030 as the number of minorities continue to increase, especially among Hispanics." ", they note.
Table. Estimated and Projected Prevalence of Alzheimer's Disease and Related Dementias (in 1000)
| Group | 2014 | 2020 | 2030 | 2040 | 2050 | 2060 |
|---|---|---|---|---|---|---|
| Non Hispanic White | 3723 (10.3%) | 4186 | 5638 | 7083 | 7365 | 7061 |
| Black | 573 (13.8%) | 726 | 1118 | 1575 | 1893 | 2173 |
| Asian and Pacific Islander | 161 (8.4%) | 212 | 356 | 554 | 761 | 999 |
| Hispanic | 430 (12.2%) | 594 | 1003 | 1620 | 2383 | 3200 |
| American Indian and Alaskan Indian | 27 (9.1%) | 38 | 65 | 100 | 130 | 156 |
| Two or more ethnic groups in the census | 43 (11.5%) | 58 | 100 | 156 | 216 | 305 |
| The figures for 2014 do not include 23 people listed as "other or unknown". | ||||||
"These results support efforts to develop a culturally competent workforce made up of health care providers of all types," the researchers write. "Such training would help improve the recognition of early signs of dementia despite cultural differences and identify ways in which health workers can help people with dementia navigate the health system."
The researchers note that early diagnosis of the disease can facilitate timely connections for patients and their caregivers. In addition, more granular data could help identify subgroups with unique SARD risks and needs.
Higher clinical suspicion needed
"We have little knowledge about the different ethnicities …. The data is not there, and new information is always good," said Douglas Scharre, MD, professor of clinical neurology and psychiatry at the Wexner Medical Center. Ohio State University in Columbus. Medscape Medical News at the request to comment.
There may be differences depending on race and ethnicity, suggest the results, and "this could lead to better treatments," he said. In addition, in terms of cultural competence, there may be better ways of assessing people of different ethnicities.
Research also raises major problems for the entire aging American population. "We are desperately late for primary care physicians who request, screen or investigate cognitive impairment," he said. He suggested, for example, screening at each Medicare health care visit for people aged 65 and over.
"The importance of this, of course, is that we know that the sooner you identify and treat, even with our current medications, the better."
The same message regarding regular screening and early identification is true for neurologists. "If we know a certain ethnicity or genetics [group] will be subject to Alzheimer's disease, we will look for it sooner, "he added." We will look more closely because we are more aware of it.
The study authors and Dr. Scharre did not reveal any relevant financial relationship.
Alzheimers Dement. Posted online 19 September 2018. Full text
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