The prevalence of Alzheimer’s Disease (AD) doubles every five years past age 65 and two thirds of those with AD are women. Among the top risk factors for AD are age, sex, and race. Black adults have a 65% greater risk of developing AD than non-Hispanic white adults, making Black women the demographic with the highest prevalence of AD among Americans aged 65 and older. Further, when it comes to AD research, women–especially Black women–are underrepresented. This lack of diversity is important to address because research findings cannot be generalizable to the wider public if all demographics are not well-represented. These statistics on prevalence come from a recent paper by Misiura and other researchers from Georgia State University, who reviewed existing research on AD, sex, and race to explore why these disparities in prevalence and research exist.
In their paper, the authors report that there are many factors contributing to greater risk of AD in Black women. AD research has shown that inflammation plays a large role in cognitive decline and later dementia. Stressors such as systemic racism, healthcare discrimination, and greater exposure to air pollution are only a few of these contributing factors. For Black women, increased social stressors increase inflammation and rates of cellular aging, contributing to higher prevalence of dementias, including AD. While chronic stress is associated with inflammation and cardiovascular risk, which can later exacerbate neurodegenerative processes, healthcare discrimination and a historical lack of trust in the healthcare system can lead to underutilization of healthcare resources. Due to these systemic disparities, Black women who develop AD are less likely to seek care early in the disease course, possibly contributing to greater cognitive deficits and functional dependence than their non-Hispanic white counterparts. Genetic research investigating AD has suggested that there may be different genes that lead to AD pathology in different demographic groups. We may not have yet discovered some of the most important genes leading to the development of Alzheimer’s in under-researched populations.
Why do these disparities in research inclusion exist? To begin, many researchers don’t have reliable networking connections with diverse populations. As a result, convenience sampling leads to cohorts that don’t represent the overall population. Screening criteria can also contribute to these discrepancies when exclusion criteria include conditions that are more common in one population than another, such as cardiovascular disease or diabetes Factors like transportation, lack of schedule flexibility, mistrust in the medical system, and barriers to care and diagnosis also make inclusion of Black women more difficult. Black American caregivers are more likely than any other subset of dementia caregivers to provide greater than 40 hours per week of care to their loved one, balance caregiving with a full-time job, and experience financial burdens. It is not hard to imagine that a combination of these circumstances make participation in research studies extraordinarily difficult.
What needs to be done so that Black women can be properly represented in research? Within study design, researchers can widen study criteria, provide sufficient compensation for time and transportation, and design cognitive tests that take cultural differences into account. However, this is not enough. We need more Alzheimer’s studies that focus on Black women. That's why we started BWITS, the Black Women: Inflammation and Tau Study, in the hopes that we can start the push toward diversifying AD research.
Find more information about BWITS here: https://www.b-wits.org/
Article of Interest:
Misiura MB, Butts B, Hammerschlag B, Munkombwe C, Bird A, Fyffe M, Hemphill A, Dotson VM, Wharton W. Intersectionality in Alzheimer's Disease: The Role of Female Sex and Black American Race in the Development and Prevalence of Alzheimer's Disease. Neurotherapeutics. 2023 Jul;20(4):1019-1036. doi: 10.1007/s13311-023-01408-x. Epub 2023 Jul 25. PMID: 37490246; PMCID: PMC10457280.
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