Racial/Ethnic Disparities in the Alzheimer’s Disease Link with Cardiovascular Disease, based on Hawaii Medicare Population

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Abstract Background There is an expanding body of literature implicating heart disease and stroke as risk factors for Alzheimer’s disease (AD). Hawaii has the most diverse ethnic population in the US and there exist racial health disparities. E.g., Native‐Hawaiians/Pacific‐Islanders (NHPI) are well‐known as a high‐risk group for a variety of conditions. In this study, we explored the association of heart disease and stroke on AD development, focusing on racial disparities. Method We utilized nine years of Hawaii Medicare data to gather information on developing heart failure (HF), ischemic heart disease (IHD), atrial fibrillation (AF), acute myocardial infarction (AMI), stroke, and progression to AD, followed by multistate models. Propensity score‐matched control groups without heart disease or stroke were identified to compare the risk of AD after heart disease and stroke. Racial effects were tested on progression to AD, accounting for risk factors Result We found increased risk of developing AD for AF (Relative Risk [RR] = 1.09, p<0.001), HF (RR = 1.21, p<0.001), IHD (RR = 1.17, p<0.001), stroke (RR = 1.15, p<0.001) and a borderline significance for the AMI (RR = 1.09, p = 0.073), compared to whites. Socioeconomic status given by the Medicare/Medicaid dual eligibility status was found to be a critical factor in AD risk and regulating racial effects. Among the individuals with a poor socio‐economic background (dual eligible), increased AD risk found for NHPIs compared to whites, from HF (RR = 1.32, p = 0.046), IHD (RR = 1.37, p = 0.004), and stroke (RR = 1.41, p = 0.025), after adjustment for multiple covariates. NHPIs had consistently increased AD risks compared to Asians from all five states: AF (RR = 1.54, p = 0.004), AMI (RR = 1.72, p = 0.024), HF (RR = 2.23, p<0.001), IHD (RR = 2.39, p<0.001), and stroke (RR = 1.85, p<0.001). Interestingly, these relationships found to be different in the Medicare‐only group, in which reduced AD risks found in NHPIs compared to whites for many conditions, including AF (RR = 0.70, p = 0.037), HF (RR = 0.54, p = 0.006), and IHD (RR = 0.75, p = 0.034). NHPIs also had reduced risk compared to Asians from HF (RR = 0.73, p<0.001) and IHD (RR = 0.58, p<0.001) to AD transition. Conclusion The risk of developing AD is high among heart disease and stroke patients, and it is varied among races.

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