By Reuters Staff

NEW YORK (Reuters Health) – A study of more than 1.8 million
U.S. veterans reveals significant differences in rates of
dementia by race and ethnicity, with rates highest in Black and
Hispanic individuals.

The cohort had a mean age of 69 years and 98% were men. Over
an average follow-up of about 10 years, 13% were diagnosed with
dementia.

Compared with white veterans, Hispanic veterans had almost
twice the risk (adjusted hazard ratio, 1.92) for developing
dementia, and Black veterans had one and a half times the risk
(aHR, 1.54), both statistically significant increases.

Adjusted rates of dementia per 1,000 person-years were 20.7
for Hispanics, 19.4 for Blacks, 14.2 for American Indian/Alaska
Natives, 12.4 for Asians and 11.5 for whites, Dr. Erica
Kornblith and colleagues of the University of California San
Francisco report in JAMA.

The rates of dementia reported by the UCSF team are in line
with findings of several prior studies including 2021 figures
from the Alzheimer Association, which found dementia rates
higher in older Blacks and Hispanics compared with white peers.

The researchers also observed geographical differences in
dementia incidence, although age-adjusted dementia incidence was
highest for Black and Hispanic people across regions in the U.S.

Differences in dementia incidence by race/ethnicity in a
population of veterans with relatively equal access to care
suggests that other factors, including early life circumstances,
may play a stronger role, or despite having access to care,
there may be differences in quality of care, the researchers
say.

In a JAMA editorial, Dr. Gwen Yeo of Stanford University
School of Medicine, in California, notes that past comparisons
of dementia rates among racial and ethnic groups have found
educational level was an important risk factor that helped
explain differences among the populations.

However, the UCSF team did not have access to the
educational level of individual veterans. “As a proxy measure,
the percentage of adults with college education in the zip codes
in which the veterans resided was used when controlling for
demographic variables. Having a more specific indicator would
have been helpful, given the potential influence of educational
level on the risk of dementia,” Dr. Yeo comments.

Despite this limitation, the study makes “an important
contribution” to the literature, “especially by the breadth of
its sample of 1.8 million veterans.”

“Clinicians should be aware of the risk factors for dementia
among ethnic and racial populations with higher rates of
dementia and help control those factors, if possible,” Dr. Yeo
advises.

“To the extent dementia can be prevented, especially in
underrepresented racial and ethnic populations, all of whom have
increased risk, clinicians will have an important
responsibility,” she concludes.

SOURCE: https://bit.ly/380AxDi and https://bit.ly/3K39pRC
JAMA, online April 19, 2022.