The state of Maryland ranks first for the highest rate of Alzheimer’s disease in the United States, even though it fares better in obesity rates, household income, and residents with health insurance.
The traditionally Democratic state located next to the nation’s capital has more than one in eight people over age 65 with the condition, compared to about one in 10 nationally.
Maryland is also the only state to have two counties with the 10 highest rates of Alzheimer’s. Baltimore City was tied for first with 16.6 percent of people over 65 and Prince George’s County was fourth with 16.1 percent.
The findings were detailed in the first report on county-level Alzheimer’s rates published in The Journal of the Alzheimer’s Association.
Megeen White, medical research advocate for the Maryland chapter of the Alzheimer’s Association, said, “The study just confirms that, yes, this is a health crisis in our community, we need to address it as such.”
Dr. Kumar Rajan, author of the report, said the prevalence of the disease in Maryland is due to a higher number of black and Hispanic residents.
These minority groups may have high rates of dementia, health experts say, because they have a higher incidence of heart disease, diabetes and high blood pressure, all conditions that affect brain health.
Previous research has shown that older black Americans are twice as likely to have Alzheimer’s or other dementias as older whites, and older Hispanics are about 1.5 times more likely to have the disease than their white counterparts due to confounding factors. comorbidities and social aspects, such as racism. and discrimination.
Diabetes is most common among African Americans, with a rate of 12 percent, and among Hispanics with a rate of 11.8 percent. Among white Americans, the rate is 7.4 percent.
High blood pressure is also more common among black Americans (56 percent) than white Americans (48 percent).
Of Baltimore City’s nearly 570,000 residents, 62.3 percent are black, compared to the national average of 9.4 percent, and 6.3 percent are Hispanic, although the national average is higher , 8.8 percent.
And throughout Maryland the number of minorities is also higher than average. In the state, 31.7 percent of residents are black and 11.5 percent are Hispanic.
New York ranked second only to Maryland, with an Alzheimer’s prevalence of 12.7 percent. However, New York has a lower rate of minorities among its total population. Just under 18 percent of New Yorkers are black and 19.7 percent are Hispanic.
New York’s Bronx County, which tied Baltimore with an Alzheimer’s prevalence of 16.6 percent, had higher minority rates than the country average, but still lower than Baltimore, at 30 percent. the population identifying as black and 47 percent as Hispanic.
However, New York state had a higher rate than Maryland of residents age 65 and older: 18.1 percent.
Health experts and Alzheimer’s specialists agree that the biggest risk factor for Alzheimer’s disease is age, and nearly 16 percent of people in Baltimore City are 65 or older, compared to the average national 12 percent. In Maryland, 17 percent of residents are 65 or older.
Ms White added: “We need to ensure sufficient awareness, education and support for everyone involved, but especially for those over 65.”
In addition to co-occurring medical conditions, the Alzheimer’s Association said the higher prevalence of the disease among blacks and Hispanics can likely be explained by social and health disparities, as well as the marginalization and discrimination of these groups in the United States, which has been deeply rooted in History.
The association highlighted structural racism, which influences housing, education, employment, safety and exposure to pollutants. It also influences access to health services, care and the prevalence of other health problems.
Following a 2022 report from the association looking at racism and dementia, Dr. Adriana Pérez, a nurse practitioner and professor of nursing at the University of Pennsylvania, said: “The continued and widespread lack of resources, as well as social factors and environmental, lead to disparities in other health outcomes such as cardiovascular disease and diabetes, which increase the risk of Alzheimer’s and other dementias.’
And Dr. Reverend Miriam Burnett, medical director of the International Health Commission of the African Methodist Episcopal Church, echoed those sentiments: “These systemic disparities are related to reduced access to important health-protective resources, such as health care. quality services and social networks that provide valuable health care. information and support.’
The cumulative stress that these factors place on a person “can directly influence the risk of dementia” among blacks and Hispanics, the association said.
Nearly 13 percent of residents age 65 and older in Maryland have Alzheimer’s disease, compared to the national average of 10.7 percent.
Counties with the most cases of Alzheimer’s
Miami-Dade County, Florida
Baltimore City, Maryland, USA
Bronx County, New York
Prince George’s C., MD
Hinds County, Mississippi
Orleans Parish, Louisiana
Orangeburg County, South Carolina
Imperial County, California
El Paso, Texas
Proportion (%), 2020
The data correspond to the proportion of the population aged 65 and over.
More recently, Ms. White acknowledged this stress: ‘(The) study found that those experiences of racism, both personal and systemic, are most likely to increase an individual’s risk of developing Alzheimer’s or another dementia. This could potentially be due to increased stress levels in the body.’
Dr. Keith Vossel, director of the Alzheimer’s disease program in the department of neurology at the University of California, Los Angeles, told DailyMail.com that marginalized groups experience stress, violence, discrimination and racism. All of these life experiences can influence epigenetic changes.
While genetic changes alter genes, epigenetic changes affect gene expression. Epigenetic changes do not physically alter DNA, but instead alter the way a gene is expressed.
Dr. Vossel stated, “These experiences can be passed down from generation to generation through epigenetic changes.”
Genetics also plays an important role in the risk of Alzheimer’s, and in 2022, researchers identified 31 new genes that appear to affect processes that play a role in the disease.
Of the genes, one called APOE-e4 has the greatest impact on risk.
Everyone inherits one of the three forms of the APOE gene from their parents (e2, e3 or e4) and scientists have found that having the e4 form of the APOE gene maximizes a person’s risk of developing the disease.
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People who inherit one copy of this gene have a three-fold increased risk and people who inherit two copies of e4 have an estimated eight to 12 times increased risk of developing dementia. These people are also more likely to develop the disease at a younger age.
African Americans are more likely than other races to have this gene.
However, the researchers emphasized that this is still a new discovery and that there are other aspects that contribute more to higher risk that need to be addressed.
Maryland has already recognized the high rate of Alzheimer’s in the state, launched a four-year plan to address the disease and passed a law to increase access to home care services for people with dementia.
The plan’s goals to address the “crisis” include increasing public awareness, educating people about the disease, improving the quality of care, supporting family caregivers, and promoting innovation through data and research.
Education and communication are two major obstacles that minority populations and the healthcare community must overcome when it comes to diagnosing and treating Alzheimer’s, Dr. Vossel said.
While mistrust leads to a lack of communication, Dr. Vossel said many people wonder why there are no doctors “who look like them” who work with dementia patients.
He added: “Unfortunately there are not enough neurologists and dementia specialists from underrepresented groups.” Doctors must be able to identify with their community.’
In addition to the lack of minority physicians, there is also a lack of access to physicians and healthcare facilities in general.
Dr. Vossel has heard from the community that they have transportation issues getting to healthcare facilities and that large or prestigious institutions that provide dementia care are not in their neighborhood, severely limiting patients’ ability to receive adequate and timely diagnosis and treatment.
Addressing the high rates of dementia in minority populations will require a multifaceted approach and Dr. Vossel said it will require everything from establishing a stable educational system that meets the needs of all its students, developing measures to combat heart disease and diabetes, Implement dementia screenings into routine doctor visits and allow doctors to be reimbursed for those screenings.