Power MC, Bennett EE, Turner RW, Dowling NM, Ciarleglio A, Glymour MM, Gianattasio KZ. Trends in Relative Incidence and Prevalence of Dementia Across Non-Hispanic Black and White Individuals in the United States, 2000-2016. JAMA Neurol. 2021 Mar 1;78(3):275-284. PubMed.
Recommends
Please login to recommend the paper.
Comments
Mayo Clinic
This is an important new piece of the puzzle about time trends in the risk of dementia. The novel observation is that the racial disparities in prevalence and incidence have not changed over 16 years, between 2000 and 2016 in the United States. The implication is that the risk or protective factors that did underlie the difference between black and white participants in 2000 continue to underlie the difference in 2016.
Some known risk or protective factors for dementia have changed over time differently in the two groups. For example, education has improved in both racial groups, but more among black participants. Hypertension and diabetes have increased in both groups, but more among black participants.
What appears to have remained stable is the effect of what the authors call structural racism. They describe structural racism as the result of life-long and complex interactions of factors such as educational attainment and quality, work experiences, income, family structure, burden of vascular risk factors, and stress caused by the personal experience of racism and discrimination. Structural racism may affect brain health at any stage of life through material, behavioral, and biological mechanisms.
Understanding the causes of the differences between blacks and whites is essential to reduce or eliminate such disparities.
View all comments by Walter A. RoccaCambridge University
This is an important analysis of the HRS data, providing as close a representation of the U.S. population as is possible, with sufficient diversity to make comparisons across time. The finding of stable relative relationships and decline in prevalence in diverse ethnicities is both bad and good. It suggests that whole societal influences are influencing shape of change, but that the relative ones are associated with others that have not changed.
It would be good to place the findings, and the authors start to do this, in the context of the changing social environments of the different populations included, and how policy changes have been the same and different across groups. This might help to disentangle what the major drivers for our populations are.
The paper’s messages that reduction is seen across time in all populations but that inequalities in this lifecourse outcome disorder for the brain are still very clear are rallying calls to policy makers to build on the success and address the enduring and unacceptable differences in our societies.
View all comments by Carol BrayneMake a Comment
To make a comment you must login or register.