Department of Health Policy, 12327Vanderbilt University School of Medicine, Nashville, TN, USA.
43353University of Minnesota School of Public Health, MN, USA.
J Appl Gerontol. 2023 May;42(5):898-908. doi: 10.1177/07334648221142851. Epub 2022 Dec 5.
To investigate how differences in income and education levels may contribute to disparities in incidence of Alzheimer's disease and related dementia (ADRD), we compared ADRD incidence in traditional Medicare claims for 11,132 Black and 7703 White participants aged 65 and over from a predominantly low-income cohort. We examined whether the relationship between ADRD incidence and race varied by income or education. Based on 2015 incident ADRD diagnoses, Black and White participants had unadjusted incidence rates of 26.5 and 23.2 cases per 1000 person-years, respectively (rate ratio 1.14, 95% CI 1.05-1.25). In multivariable Cox proportional hazard models, the relationship between race and incident ADRD diagnosis did not vary by education level (p-interaction = 0.748) but was modified by income level (p-interaction = 0.007), with higher ADRD incidence among Black participants observed only among higher income groups. These results highlight the importance of understanding how race and economic factors influence ADRD incidence and diagnosis rates.
为了探究收入和受教育程度的差异如何导致阿尔茨海默病和相关痴呆症（ADRD）发病率的差异，我们比较了来自以低收入为主的队列的 11132 名黑人参与者和 7703 名白人参与者的传统医疗保险索赔中的 ADRD 发病率。我们检验了 ADRD 发病率与种族之间的关系是否因收入或教育水平而异。根据 2015 年的 ADRD 发病诊断，黑人参与者和白人参与者的未调整发病率分别为每 1000 人年 26.5 例和 23.2 例（发病率比 1.14，95%CI 1.05-1.25）。在多变量 Cox 比例风险模型中，种族与 ADRD 发病诊断之间的关系不受教育程度的影响（p 交互作用=0.748），但受收入水平的影响（p 交互作用=0.007），仅在收入较高的组中观察到黑人参与者的 ADRD 发病率较高。这些结果强调了理解种族和经济因素如何影响 ADRD 发病率和诊断率的重要性。
