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Zhu Y, Park S, Kolady R, Zha W, Ma Y, Dias A, McGuire K, Hardi A, Lin S, Ismail Z, Adkins‐Jackson PB, Trani J, Babulal GM. A systematic review/meta-analysis of prevalence and incidence rates illustrates systemic underrepresentation of individuals racialized as Asian and/or Asian-American in ADRD research. Alzheimers Dement 2024; 20:4315-4330. [PMID: 38708587 PMCID: PMC11180860 DOI: 10.1002/alz.13820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 03/04/2024] [Accepted: 03/11/2024] [Indexed: 05/07/2024]
Abstract
We investigate Alzheimer's disease and related dementia (ADRD) prevalence, incidence rate, and risk factors in individuals racialized as Asian and/or Asian-American and assess sample representation. Prevalence, incidence rate, risk factors, and heterogeneity of samples were assessed. Random-effects meta-analysis was conducted, generating pooled estimates. Of 920 records across 14 databases, 45 studies were included. Individuals racialized as Asian and/or Asian-American were mainly from Eastern and Southern Asia, had higher education, and constituted a smaller sample relative to non-Hispanic white cohorts. The average prevalence was 10.9%, ranging from 0.4% to 46%. The average incidence rate was 20.03 (12.01-33.8) per 1000 person-years with a range of 75.19-13.59 (12.89-14.33). Risk factors included physiological, genetic, psychological, behavioral, and social factors. This review underscores the systemic underrepresentation of individuals racialized as Asian and/or Asian-American in ADRD research and the need for inclusive approaches accounting for culture, language, and immigration status. HIGHLIGHTS: There is considerable heterogeneity in the prevalence of ADRD among studies of Asian-Americans. There is limited data on group-specific risk factors for ADRD among Asian-Americans. The average prevalence of (ADRD) among Asian-Americans was found to be 7.4%, with a wide range from 0.5% to 46%.
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Affiliation(s)
- Yiqi Zhu
- School of Social WorkAdelphi UniversityGarden CityNew YorkUSA
| | - Soobin Park
- Brown SchoolWashington University in St. LouisSt. LouisMissouriUSA
| | | | - Wenqing Zha
- Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
| | - Ying Ma
- University of Houston56B M.D. Anderson Library HoustonTexasUSA
| | - Amanda Dias
- School of Social WorkAdelphi UniversityGarden CityNew YorkUSA
| | | | - Angela Hardi
- Bernard Becker Medical LibraryWashington University School of MedicineSt. LouisMissouriUSA
| | - Sunny Lin
- Division of General Medical SciencesDepartment of MedicineWashington University School of MedicineSt. LouisMissouriUSA
| | - Zahinoor Ismail
- Departments of PsychiatryClinical Neurosciences, and Community Health SciencesHotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Department of Clinical and Biomedical SciencesFaculty of Health and Life SciencesUniversity of ExeterDevonUK
| | - Paris B. Adkins‐Jackson
- Departments of Epidemiology and Sociomedical SciencesMailman School of Public HealthColumbia UniversityNew YorkNew YorkUSA
| | - Jean‐Francois Trani
- Brown SchoolWashington University in St. LouisSt. LouisMissouriUSA
- Institute of Public HealthWashington UniversitySt. LouisMissouriUSA
- Centre for Social Development in AfricaFaculty of HumanitiesUniversity of JohannesburgCnr Kingsway & University RoadsJohannesburgSouth Africa
- National Conservatory of Arts and CraftsParisFrance
| | - Ganesh M. Babulal
- Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
- Institute of Public HealthWashington UniversitySt. LouisMissouriUSA
- National Conservatory of Arts and CraftsParisFrance
- Department of Clinical Research and LeadershipThe George Washington University School of Medicine and Health SciencesWashingtonDistrict of ColumbiaUSA
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Melcher EM, Vilen L, Pfaff A, Lim S, DeWitt A, Powell WR, Bendlin BB, Kind AJH. Deriving life-course residential histories in brain bank cohorts: A feasibility study. Alzheimers Dement 2024; 20:3219-3227. [PMID: 38497250 PMCID: PMC11095419 DOI: 10.1002/alz.13773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION The exposome is theorized to interact with biological mechanisms to influence risk for Alzheimer's disease but is not well-integrated into existing Alzheimer's Disease Research Center (ADRC) brain bank data collection. METHODS We apply public data tracing, an iterative, dual abstraction and validation process rooted in rigorous historic archival methods, to develop life-course residential histories for 1254 ADRC decedents. RESULTS The median percentage of the life course with an address is 78.1% (IQR 24.9); 56.5% of the sample has an address for at least 75% of their life course. Archivists had 89.7% agreement at the address level. This method matched current residential survey methodology 97.4% on average. DISCUSSION This novel method demonstrates feasibility, reproducibility, and rigor for historic data collection. To our knowledge, this is the first study to show that public data tracing methods for brain bank decedent residential history development can be used to better integrate the social exposome with biobank specimens. HIGHLIGHTS Public data tracing compares favorably to survey-based residential history. Public data tracing is feasible and reproducible between archivists. Archivists achieved 89.7% agreement at the address level. This method identifies residences for nearly 80% of life-years, on average. This novel method enables brain banks to add social characterizations.
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Affiliation(s)
- Eleanna M. Melcher
- Department of Population Health SciencesUniversity of Wisconsin School of Medicine and Public HealthWarf Office BldgMadisonUSA
- Center for Health Disparities ResearchUniversity of Wisconsin School of Medicine and Public HealthUW Hospital and ClinicsMadisonUSA
| | - Leigha Vilen
- Center for Health Disparities ResearchUniversity of Wisconsin School of Medicine and Public HealthUW Hospital and ClinicsMadisonUSA
| | - Aly Pfaff
- Center for Health Disparities ResearchUniversity of Wisconsin School of Medicine and Public HealthUW Hospital and ClinicsMadisonUSA
| | - Sarah Lim
- Center for Health Disparities ResearchUniversity of Wisconsin School of Medicine and Public HealthUW Hospital and ClinicsMadisonUSA
| | - Amanda DeWitt
- Center for Health Disparities ResearchUniversity of Wisconsin School of Medicine and Public HealthUW Hospital and ClinicsMadisonUSA
| | - W. Ryan Powell
- Center for Health Disparities ResearchUniversity of Wisconsin School of Medicine and Public HealthUW Hospital and ClinicsMadisonUSA
- Department of Medicine Division of Geriatrics and GerontologyUniversity of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 5158Medical Foundation Centennial BuildingMadisonUSA
| | - Barbara B. Bendlin
- Center for Health Disparities ResearchUniversity of Wisconsin School of Medicine and Public HealthUW Hospital and ClinicsMadisonUSA
- Department of Medicine Division of Geriatrics and GerontologyUniversity of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 5158Medical Foundation Centennial BuildingMadisonUSA
- Wisconsin Alzheimer's Disease Research CenterMadisonUSA
| | - Amy J. H. Kind
- Center for Health Disparities ResearchUniversity of Wisconsin School of Medicine and Public HealthUW Hospital and ClinicsMadisonUSA
- Department of Medicine Division of Geriatrics and GerontologyUniversity of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 5158Medical Foundation Centennial BuildingMadisonUSA
- Wisconsin Alzheimer's Disease Research CenterMadisonUSA
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Kim B, Yannatos I, Blam K, Wiebe D, Xie SX, McMillan CT, Mechanic‐Hamilton D, Wolk DA, Lee EB. Neighborhood disadvantage reduces cognitive reserve independent of neuropathologic change. Alzheimers Dement 2024; 20:2707-2718. [PMID: 38400524 PMCID: PMC11032541 DOI: 10.1002/alz.13736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Individuals in socioeconomically disadvantaged neighborhoods exhibit increased risk for impaired cognitive function. Whether this association relates to the major dementia-related neuropathologies is unknown. METHODS This cross-sectional study included 469 autopsy cases from 2011 to 2023. The relationships between neighborhood disadvantage measured by Area Deprivation Index (ADI) percentiles categorized into tertiles, cognition evaluated by the last Mini-Mental State Examination (MMSE) scores before death, and 10 dementia-associated proteinopathies and cerebrovascular disease were assessed using regression analyses. RESULTS Higher ADI was significantly associated with lower MMSE score. This was mitigated by increasing years of education. ADI was not associated with an increase in dementia-associated neuropathologic change. Moreover, the significant association between ADI and cognition remained even after controlling for changes in major dementia-associated proteinopathies or cerebrovascular disease. DISCUSSION Neighborhood disadvantage appears to be associated with decreased cognitive reserve. This association is modified by education but is independent of the major dementia-associated neuropathologies.
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Affiliation(s)
- Boram Kim
- Translational Neuropathology Research LaboratoryDepartment of Pathology and Laboratory MedicinePerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Isabel Yannatos
- Penn Frontotemporal Degeneration CenterDepartment of NeurologyPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Kaitlin Blam
- Translational Neuropathology Research LaboratoryDepartment of Pathology and Laboratory MedicinePerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Douglas Wiebe
- Department of Emergency MedicineDepartment of EpidemiologyUniversity of MichiganAnn ArborMichiganUSA
| | - Sharon X. Xie
- Department of BiostatisticsEpidemiology and InformaticsPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Corey T. McMillan
- Penn Frontotemporal Degeneration CenterDepartment of NeurologyPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Dawn Mechanic‐Hamilton
- Penn Memory CenterDepartment of NeurologyPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - David A. Wolk
- Penn Memory CenterDepartment of NeurologyPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Edward B. Lee
- Translational Neuropathology Research LaboratoryDepartment of Pathology and Laboratory MedicinePerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Wong R, Soong D. Disparities in neighbourhood characteristics and 10-year dementia risk by nativity status. Epidemiol Psychiatr Sci 2024; 33:e7. [PMID: 38356391 PMCID: PMC10894703 DOI: 10.1017/s2045796024000076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 12/27/2023] [Accepted: 01/21/2024] [Indexed: 02/16/2024] Open
Abstract
AIMS Prior research indicates that neighbourhood disadvantage increases dementia risk. There is, however, inconclusive evidence on the relationship between nativity and cognitive impairment. To our knowledge, our study is the first to analyse how nativity and neighbourhood interact to influence dementia risk. METHODS Ten years of prospective cohort data (2011-2020) were retrieved from the National Health and Aging Trends Study, a nationally representative sample of 5,362 U.S. older adults aged 65+. Cox regression analysed time to dementia diagnosis using nativity status (foreign- or native-born) and composite scores for neighbourhood physical disorder (litter, graffiti and vacancies) and social cohesion (know, help and trust each other), after applying sampling weights and imputing missing data. RESULTS In a weighted sample representing 26.9 million older adults, about 9.5% (n = 2.5 million) identified as foreign-born and 24.4% (n = 6.5 million) had an incident dementia diagnosis. Average baseline neighbourhood physical disorder was 0.19 (range 0-9), and baseline social cohesion was 4.28 (range 0-6). Baseline neighbourhood physical disorder was significantly higher among foreign-born (mean = 0.28) compared to native-born (mean = 0.18) older adults (t = -2.4, p = .02). Baseline neighbourhood social cohesion was significantly lower for foreign-born (mean = 3.57) compared to native-born (mean = 4.33) older adults (t = 5.5, p < .001). After adjusting for sociodemographic, health and neighbourhood variables, foreign-born older adults had a 51% significantly higher dementia risk (adjusted hazard ratio = 1.51, 95% CI = 1.19-1.90, p < .01). There were no significant interactions for nativity with neighbourhood physical disorder or social cohesion. CONCLUSIONS Our findings suggest that foreign-born older adults have higher neighbourhood physical disorder and lower social cohesion compared to native-born older adults. Despite the higher dementia risk, we observed for foreign-born older adults, and this relationship was not moderated by either neighbourhood physical disorder or social cohesion. Further research is needed to understand what factors are contributing to elevated dementia risk among foreign-born older adults.
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Affiliation(s)
- R. Wong
- Department of Public Health and Preventive Medicine, Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
- Department of Geriatrics, SUNY Upstate Medical University, Syracuse, NY, USA
| | - D. Soong
- Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
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Li C, Mowery DL, Ma X, Yang R, Vurgun U, Hwang S, Donnelly HK, Bandhey H, Akhtar Z, Senathirajah Y, Sadhu EM, Getzen E, Freda PJ, Long Q, Becich MJ. Realizing the Potential of Social Determinants Data: A Scoping Review of Approaches for Screening, Linkage, Extraction, Analysis and Interventions. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.04.24302242. [PMID: 38370703 PMCID: PMC10871446 DOI: 10.1101/2024.02.04.24302242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Background Social determinants of health (SDoH) like socioeconomics and neighborhoods strongly influence outcomes, yet standardized SDoH data is lacking in electronic health records (EHR), limiting research and care quality. Methods We searched PubMed using keywords "SDOH" and "EHR", underwent title/abstract and full-text screening. Included records were analyzed under five domains: 1) SDoH screening and assessment approaches, 2) SDoH data collection and documentation, 3) Use of natural language processing (NLP) for extracting SDoH, 4) SDoH data and health outcomes, and 5) SDoH-driven interventions. Results We identified 685 articles, of which 324 underwent full review. Key findings include tailored screening instruments implemented across settings, census and claims data linkage providing contextual SDoH profiles, rule-based and neural network systems extracting SDoH from notes using NLP, connections found between SDoH data and healthcare utilization/chronic disease control, and integrated care management programs executed. However, considerable variability persists across data sources, tools, and outcomes. Discussion Despite progress identifying patient social needs, further development of standards, predictive models, and coordinated interventions is critical to fulfill the potential of SDoH-EHR integration. Additional database searches could strengthen this scoping review. Ultimately widespread capture, analysis, and translation of multidimensional SDoH data into clinical care is essential for promoting health equity.
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Affiliation(s)
- Chenyu Li
- University of Pittsburgh School of Medicine Department of Biomedical Informatics
| | - Danielle L. Mowery
- University of Pennsylvania, Institute for Biomedical Informatics
- University of Pennsylvania, Department of Biostatistics, Epidemiology and Informatics
| | - Xiaomeng Ma
- University of Toronto, Institute of Health Policy Management and Evaluations
| | - Rui Yang
- Duke-NUS Medical School, Centre for Quantitative Medicine
| | - Ugurcan Vurgun
- University of Pennsylvania, Institute for Biomedical Informatics
| | - Sy Hwang
- University of Pennsylvania, Institute for Biomedical Informatics
| | | | - Harsh Bandhey
- Cedars-Sinai Medical Center, Department of Computational Biomedicine
| | - Zohaib Akhtar
- Northwestern University, Kellogg School of Management
| | - Yalini Senathirajah
- University of Pittsburgh School of Medicine Department of Biomedical Informatics
| | - Eugene Mathew Sadhu
- University of Pittsburgh School of Medicine Department of Biomedical Informatics
| | - Emily Getzen
- University of Pennsylvania, Department of Biostatistics, Epidemiology and Informatics
| | - Philip J Freda
- Cedars-Sinai Medical Center, Department of Computational Biomedicine
| | - Qi Long
- University of Pennsylvania, Institute for Biomedical Informatics
- University of Pennsylvania, Department of Biostatistics, Epidemiology and Informatics
| | - Michael J. Becich
- University of Pittsburgh School of Medicine Department of Biomedical Informatics
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Maniscalco L, Veronese N, Ragusa FS, Vernuccio L, Dominguez LJ, Smith L, Matranga D, Barbagallo M. Sarcopenia using muscle mass prediction model and cognitive impairment: A longitudinal analysis from the English longitudinal study on ageing. Arch Gerontol Geriatr 2024; 117:105160. [PMID: 37672877 DOI: 10.1016/j.archger.2023.105160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/11/2023] [Accepted: 08/13/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Literature on the association between sarcopenia and cognitive impairment is largely unclear and mainly limited to non-European populations. Therefore, the aim of this study is to explore if the presence of sarcopenia at the baseline could increase the risk of cognitive impairment in a large cohort of older people participating to the English Longitudinal Study of Ageing (ELSA), over ten years of follow-up. METHODS Sarcopenia was diagnosed as having low handgrip strength and low skeletal muscle mass index at the baseline, using a muscle mass prediction model; cognitive function was evaluated in the ELSA through several tests. The results are reported in the whole sample adjusted for potential baseline confounders and after matching sarcopenic and non-sarcopenic participants with a propensity score. RESULTS 2738 people (mean age: 68.7 years, 54.4% males) were included. During the ten years of follow-up, sarcopenia was associated with significantly lower scores in memory (p < 0.001), verbal fluency (p < 0.001), immediate word recall (p <0.001), delayed word recall (p = 0.018), and in recall summary score (p < 0.001). After adjusting for eight potential confounders, the presence of sarcopenia was significantly associated with poor verbal fluency (odds ratio, OR= 1.417, 95% confidence intervals, CI= 1.181-1.700) and in propensity-score matched analyses (OR=1.272, 95%CI= 1.071- 1.511). CONCLUSIONS AND IMPLICATIONS Sarcopenia was found to be associated with a significantly higher incidence of poor cognitive status in a large population of elderly people followed up for 10 years, suggesting it may be an important potential risk factor for dementia.
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Affiliation(s)
- Laura Maniscalco
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Italy
| | - Nicola Veronese
- Department of Internal Medicine and Geriatrics, Geriatric Unit, University of Palermo, Via del Vespro, 141, Palermo 90127, Italy.
| | - Francesco Saverio Ragusa
- Department of Internal Medicine and Geriatrics, Geriatric Unit, University of Palermo, Via del Vespro, 141, Palermo 90127, Italy
| | - Laura Vernuccio
- Department of Internal Medicine and Geriatrics, Geriatric Unit, University of Palermo, Via del Vespro, 141, Palermo 90127, Italy
| | - Ligia J Dominguez
- Faculty of Medicine and Surgery, Kore University of Enna, Enna, Italy
| | - Lee Smith
- Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Domenica Matranga
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Italy
| | - Mario Barbagallo
- Department of Internal Medicine and Geriatrics, Geriatric Unit, University of Palermo, Via del Vespro, 141, Palermo 90127, Italy
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Wang K, Zhu Z, Qi X. Socioeconomic Status Disparities in Cognitive and Physical Functional Impairment among Older Adults: Comparison of Asians with other Major Racial/Ethnic Groups. J Urban Health 2023; 100:839-851. [PMID: 37552453 PMCID: PMC10447797 DOI: 10.1007/s11524-023-00768-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 08/09/2023]
Abstract
This study investigated to what extent socioeconomic status (SES) disparity associates with cognitive and physical impairment within older Asian Americans in comparison with other races/ethnicities. Data were from the National Health and Nutrition Examination Survey 2011-2018 that included 3,297 White, 1,755 Black, 1,708 Hispanic, and 730 Asian Americans aged ≥ 60. Physical functioning was measured by activities of daily living (ADL) or instrumental activities of daily living (IADL). Memory and language fluency were evaluated using the Alzheimer's Disease Word List Memory Task and Animal Fluency Tests, respectively. Multivariate logistic regressions were conducted to investigate the association between SES and physical and cognitive impairment within racial/ethnic groups, and seemingly unrelated regressions compared coefficients across subgroups. Asians with ≤ high school education had the highest prevalence of age- and sex-adjusted memory impairment among all races/ethnicities, while no difference was observed for those with > high school education. ADL/IADL disability odds did not differ between Asians and Whites, but Asians were more likely to exhibit impaired verbal fluency. Education disparity for ADL disability (OR, 3.40; 95% CI, 2.20-5.25) and memory impairment (OR, 11.57; 95% CI, 6.59-20.31) were largest among Asians compared to Whites, Blacks, and Hispanics. Income disparity for function impairment showed no significant difference across racial/ethnic groups (all P > 0.05). Asians experienced the highest burden of physical functioning and memory impairment due to education disparity. Efforts should focus on strengthening research infrastructure and creating targeted programs and services to improve cognitive and physical health for racially/ethnically underrepresented older adults with lower education attainment.
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Affiliation(s)
- Katherine Wang
- Trinity College of Arts and Sciences, Duke University, NC, Durham, USA
| | - Zheng Zhu
- Rory Meyers College of Nursing, New York University, 433 1St Ave, New York, NY, 10010, USA
- School of Nursing, Fudan University, Shanghai, China
| | - Xiang Qi
- Rory Meyers College of Nursing, New York University, 433 1St Ave, New York, NY, 10010, USA.
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