Portrait of an elderly Black man looking sad and away from the camera.
Image credit: pixelheadphoto on istock.com

Alzheimer’s is a disease whose devastating impact tends to cut across many of the lines that typically separate health outcomes in the United States, like race, wealth, and even age. Yet even so, the impact of Alzheimer’s on Americans is complicated by longstanding and structural inequality.

“Communities of color suffer from Alzheimer’s disease and dementia at far higher rates than whites, but are less likely to be diagnosed until much later,” notes the University of Southern California’s Annenberg Center for Health Journalism in the introduction to their recent webinar, “Reporting on Alzheimer’s Unequal Toll in Communities of Color.” 

The impact of Alzheimer’s on Americans is complicated by longstanding and structural inequality.“Even with a diagnosis, African Americans are far more likely to experience worse care from health care systems filled with bias and discrimination. Family members who care for loved ones with the disease are forced to navigate this difficult health care landscape while often putting their own lives on hold,” the Center notes. 

A Disproportionate Impact 

The impact of Alzheimer’s on non-White Americans, and Black Americans in particular, is profound. 

The disease affects Black Americans at twice the rate of non-Latinx White Americans, while Latinx people are affected at least one-and-a-half times as much, said Stephanie J. Monroe, vice president and senior advisor of health equity and access at UsAgainstAlzheimer’s, a national advocacy organization based in Washington, DC. 

“There’s not a lot understood in terms of exactly why that is, but we are learning more,” said Monroe, noting that Alzheimer’s is associated with families that have vascular issues, heart disease, cardiovascular issues, diabetes, obesity. 

“Things of that nature seem to be a predictor of families who go on to develop Alzheimer’s,” said Monroe. “You have social and structural determinants of health that make Alzheimer’s something that frankly you can see on a map by the zip code.” 

“Educational level and quality of education, the environment, food and good nutrition, clean environments, opportunities to exercise, all of these things seem to be factoring into communities in terms of whether they will likely have a higher prevalence of Alzheimer’s disease or less,” said Monroe. 

In other words, Alzheimer’s is a medical condition with deep social, economic, and racial dimensions, at least here in the United States.

“We know the biology matters. We know the genetics matter. And now we’re learning more and more about where you live and grow and work—that seems to matter as well,” said Monroe. 

“African Americans are far more likely to experience worse care from health care systems filled with bias and discrimination.”

A Multitude of Factors

The links between Alzheimer’s and socioeconomic factors—including and especially race—are complex, multilayered, and not yet fully understood, the panelists of the USC webinar emphasized. 

But what is becoming very clear, they said, is that some of the same racial disparities seen in other maladies play a role in the disproportionate incidence of Alzheimer’s in BIPOC communities.

“We recognize that in the Black community, there are so many daily challenges to navigate and that this is one more,” said Petra Niles, gerontologist and senior manager of African American Outreach at Alzheimer’s Los Angeles. 

Among the factors that can contribute to Alzheimer’s, Niles said, are high blood pressure, diabetes, and high cholesterol—factors disproportionately present in Black communities and other communities of color.

The disparities don’t end there. People in BIPOC communities, Niles notes, are more likely to lack access to high-quality, nearby medical services and transportation to get to such facilities, and are less likely to have the means to provide or pay for care for those affected with Alzheimer’s.

“I started to see a lot of coverage that was blaming the co-morbidities that Black Americans are much more likely to suffer.”

All of that means that more attention, more resources, and more education need to be invested in communities of color to deal with the realities and burdens of Alzheimer’s. 

“What does a support system look like for an individual who has taken on the role of a caregiver?” asked Niles.

“There are a number of opportunities to look at support systems,” said Niles. “It takes a village to be able to handle this.” 

Diagnosing Longstanding Inequities 

At the height of the COVID-19 pandemic, while reporting on racial disparities in the impacts of the virus, Reuters’s Global Race and Justice Editor Kat Stafford noticed a trend in how these disparities were being perceived in various media.

“I started to see a lot of coverage that was blaming the co-morbidities that Black Americans are much more likely to suffer,” noted Stafford, “and not a lot of analysis or not enough analysis of how we got to this point. Why was this something that was able to create a perfect storm where we saw these disparate health outcomes?” 

In a series for Reuters, Stafford made the case that “this legacy of racism in our nation has really laid the foundation in many ways for much of what we have seen over decades and decades” of racial health disparities. 

Those disparities—in everything from blood pressure levels to exposure to pollution to access to healthy food to quality healthcare—in many cases represent co-morbidities for yet other serious health challenges—including Alzheimer’s.  

And underlying these disparities, Stafford said, is decades of structural racism. 

“It’s not just as simple as someone isn’t being cautious about their diet,” noted Stafford. “All of these health inequities were not things that just happened overnight. These were generations in the making. These are generational in that they have, in large part, been caused by the effects of structural racism, redlining, discrimination, segregation.”

Alzheimer’s, in other words, appears to be two things at once when it comes to the disease’s impact on BIPOC communities: a disease disproportionately affecting those communities on the one hand and, on the other, at least to some extent the result of long-term health inequities.

Reducing the impact of Alzheimer’s on Americans of color, USC’s expert panel agreed, will require dealing both with the disease on its own terms and as a symptom of deeper structural health injustices.