Title : Racial/Ethnic disparities in the alzheimer's disease link with heart disease and stroke, based on hawaii medicare population
There is an expanding body of literature implicating heart disease and stroke as a risk factor for Alzheimer disease (AD), highlighting significant pathways. Hawaii state has the most diverse ethnic population in the US and there exists significant racial health disparities. E.g., Native Hawaiians and Pacific Islanders (NHPI) are widely known as a high-risk group for variety of conditions, including cardiovascular conditions. We explored the association of heart disease and stroke on AD development based on on the Hawaii Medicare data, focusing on racial disparities on this link.
9 years of Medicare data was used to gather information on developing heart failure (HF), ischemic heart disease (IHD), atrial fibrillation (AF), acute myocardial infarction (AMI), stroke, and then progression to AD, followed by the progressive multistate model (Figure). Covariate matched control groups without heart disease or stroke were identified using the propensity score matching to compare the risk of AD after heart disease and stroke. Next, racial effects were tested on progression to AD while accounting for multiple risk factors.
We found increased risks of developing AD for AF(RR=1.09,p<0.01), HF(RR=1.21, p<0.01), IHD(RR=1.17,p<0.01), and stroke(RR=1.15,p<0.01), compared to controls. Socio-economic(SE) status was found to critical factor in AD risk. Among the low SE group, increased AD risks were found in NHPIs compared to whites for HF(RR=1.32, p=0.04), IHD(RR=1.37, p<0.01), and stroke(RR=1.41,p=0.03) states. They also had increased AD risks compared to Asians from all states: AF(RR=1.54, p<0.01), AMI(RR=1.72,p=0.02), HF(RR=2.23,p<0.01), IHD(RR=2.39,p<0.01), and stroke(RR=1.85,p<0.01). Interestingly, these observations were found reversed in the high SE group, showing reduced AD risks for NHPIs compared to whites for AF(RR=0.70,p=0.04), HF(RR=0.54,p=0.01), IHD(RR=0.75,p=0.03). NHPIs also had reduced risk compared to Asians from HF(RR=0.73,p<0.01) and IHD(RR=0.58,p<0.01) on AD.
This study shows an increased risk of developing AD among subjects who developed AF, AMI, CHD, IHD and stroke conditions, showing a progressive disease relationship. There exist significant racial ethnic disparities within the link of heart disease and stroke to AD, while looking at the Hawaii population. NHPIs with poor SE status seems to be mostly disadvantaged by the heart/stroke and AD link compared to Whites and Asians.
Audience Take Away
- This work explains data driven evidence on the risk of developing Alzheimer’s disease for heart disease and stroke patients, following a multistate model
- It shows how race and socioeconomic status influence the link of heart disease and stroke to Alzheimer’s disease, highlighting potential risk groups
- This work increases the awareness of heart disease and stroke link on Alzheimer’s disease, which may help come up with interdisciplinary initiatives to increase awareness among both practitioners and patients. For a state such as Hawaii which has a strong racial diversity, the sense of racial effects may result in benefits for elderly patients from appropriate evidence-based treatment
- The link between heart disease and stroke is not widely explored in research setting, but more importantly, racial effects on this link never explored in the literature. This work will increase the awareness of such dependency and help generating new research avenues for neuroscience researchers/epidemiologists