Differences in survival and mortality in minority ethnic groups with dementia: A systematic review and meta‐analysis

Abstract

Objectives Although there are disparities in both risk of developing dementia and accessibility of dementia services for certain minority ethnic groups in the United States and United Kingdom, disparities in survival after a dementia diagnosis are less well‐studied. Our objective was to systematically review the literature to investigate racial/ethnic differences in survival and mortality in dementia. Methods We searched Embase, Ovid MEDLINE, Global Health and PsycINFO from inception to November 2018 for studies comparing survival or mortality over time in at least two race/ethnicity groups. Studies from any country were included but analysed separately. We used narrative synthesis and random‐effects meta‐analysis to synthesise findings. The Newcastle–Ottawa Scale was used to assess quality and risk of bias in individual studies. Results We identified 22 articles, most from the United States (n = 17), as well as the United Kingdom (n = 3) and the Netherlands (n = 1). In a meta‐analysis of US studies, hazard of mortality was lower in Black/African American groups (Pooled Hazard Ratio = 0.86, 95% CI = 0.82–0.91, I2 = 17%, from four studies) and Hispanic/Latino groups (Pooled HR = 0.65, 95% CI = 0.50–0.84, I2 = 86%, from four studies) versus comparison groups. However, study quality was mixed, and in particular, quality of reporting of race/ethnicity was inconsistent. Conclusion Literature indicates that Black/African American and Hispanic/Latino groups may experience lower mortality in dementia versus comparison groups in the United States, but further research, using clearer and more and consistent reporting of race/ethnicity, is necessary to understand what drives these patterns and their implications for policy and practice.

Expanding the scope of health disparities research in Alzheimer's disease and related dementias

“…The age‐adjusted cause‐specific AD/ADRD mortality ratios among non‐Hispanics were 0.92 for Black/White and 0.65 for Hispanic/non‐Hispanic 17 . Lower mortality and higher incidence of AD/ADRD are consistent with better survival in disadvantaged populations observed in some studies 18,19 . The death hazard ratios for individuals diagnosed with dementia obtained in meta‐analyses were 0.86 and 0.65, respectively, for Black and Hispanic populations 19 .…”

“…17 Lower mortality and higher incidence of AD/ADRD are consistent with better survival in disadvantaged populations observed in some studies. 18,19 The death hazard ratios for individuals diagnosed with dementia obtained in meta-analyses were 0.86 and 0.65, respectively, for Black and Hispanic populations. 19 Additional support for these findings were presented during the workshop, 12 extending existing work based on Medicare data; 16,20 Black and Hispanic subpopulations demonstrated higher risk for both AD and ADRD when compared to non-Hispanic Whites (AD hazard ratios of 1.33 for Black and 1.21 for Hispanic) but lower survival post AD/ADRD onset (AD hazard ratios of 0.86 and 0.69).…”

Excess Mortality With Alzheimer Disease and Related Dementias as an Underlying or Contributing Cause During the COVID-19 Pandemic in the US

“…Research conducted prior to the pandemic has yielded inconsistent results on racial and ethnic disparities in ADRD mortality. 21 , 22 , 23 , 24 , 25 While we could not directly assess racial and ethnic disparities in ADRD-related mortality without population data on the number of individuals living with ADRD by race and ethnicity, our analysis of mortality differences by race and ethnicity highlights concerning patterns in excess ADRD-related deaths during the pandemic. Our findings for year 1 suggest that Black older adults with ADRD experienced substantially higher excess deaths in the early pandemic.…”

The Impact of Demographic, Socio-Economic and Geographic Factors on Mortality Risk among People Living with Dementia in England (2002–2016)

“…Existing research examines the impact of few social, demographic or geographic factors in mortality risk among PLWD [1,2,40]. Yet none focus on multiple risk factors or investigate healthcare contacts as explanatory factors in health outcomes for PLWD.…”