George Washington University Biomedical Informatics Center, Washington, DC, USA.
Washington DC VA Medical Center, Washington, DC, USA.
J Alzheimers Dis. 2020;75(1):311-320. doi: 10.3233/JAD-191188.
Racial disparity in the epidemiology of Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD) has been reported. However, less is known about this disparity among Veterans.
To estimate the racial disparity in AD/ADRD among the Veterans.
Of the 5,413,418 Veterans≥65 years receiving care at the Veterans Health Administration (1999-2016), 4,045,269 were free of prevalent AD/ADRD, schizophrenia, or bipolar disorder at baseline. Of these, 432,469 were African American. Race was self-identified and incident AD/ADRD during 20 (median 6.7) years of follow-up was ascertained using International Classification of Diseases codes.
Patients had a mean age of 70.4 (±6.6) years and 97.8% were men. Age-sex-adjusted incidence of AD/ADRD per 1,000 person-year was 19.3 and 10.8 for African American and white Veterans, respectively (age-sex-adjusted hazard ratio associated with African American race, 1.77; 95% confidence interval, 1.75-1.79; p < 0.0001). This association remained essentially unchanged after multivariable adjustment (hazard ratio, 1.67; 95% confidence interval, 1.65-1.69; p < 0.0001). Among the key baseline characteristics that were significant predictors of AD/ADRD in both races, stroke was a significantly stronger predictor among African Americans, and Hispanic ethnicity and depression among whites (p-value for all interaction,<0.0001).
The findings of a higher incidence of AD/ADRD among African American Veterans is consistent with the findings in the general population reported in the literature, although the overall incidence appears to be lower than that in the general population. Future studies need to examine this disparity in incidence as well as the between-race heterogeneity in AD/ADRD risk.
阿尔茨海默病和与阿尔茨海默病相关的痴呆症（AD/ADRD）的流行病学存在种族差异，这已得到报道。然而，关于退伍军人中的这种差异，人们知之甚少。
评估退伍军人中 AD/ADRD 的种族差异。
在退伍军人健康管理局（1999-2016 年）接受治疗的≥65 岁的 5413418 名退伍军人中，有 4045269 人在基线时无 AD/ADRD、精神分裂症或双相情感障碍。其中 432469 人为非裔美国人。种族由自我认定，在 20 年（中位数为 6.7 年）的随访期间，通过国际疾病分类代码确定 AD/ADRD 的发病情况。
患者的平均年龄为 70.4（±6.6）岁，97.8%为男性。每 1000 人年 AD/ADRD 的年龄-性别调整发病率分别为 19.3 和 10.8，非裔美国人和白人退伍军人分别为 19.3 和 10.8（与非裔美国人种族相关的年龄-性别调整风险比，1.77；95%置信区间，1.75-1.79；p<0.0001）。多变量调整后，这种关联基本保持不变（风险比，1.67；95%置信区间，1.65-1.69；p<0.0001）。在两个种族中均为 AD/ADRD 的重要基线特征中，卒中是非裔美国人 AD/ADRD 的更强预测因素，而西班牙裔和抑郁症则是白人的更强预测因素（所有交互作用的 p 值均<0.0001）。
非裔美国退伍军人中 AD/ADRD 发病率较高的发现与文献报道的一般人群中的发现一致，尽管总体发病率似乎低于一般人群。未来的研究需要检查这种发病率差异以及 AD/ADRD 风险的种族间异质性。
