Geographical Differences in the Occurrence of Alzheimer's Disease Mortality: United States Versus Puerto Rico

Abstract

Background Alzheimer’s disease (AD) is the most prevalent type of dementia. Although the pathobiology of AD is still not understood, certain risk factors have been identified. The most asserted risk factors are age and genetics. Here, the age-adjusted AD mortality in Puerto Rico (PR) and United States (US) from 1999 to 2004 was analyzed, using the Tenth International Classification of Disease coding system. Method The numbers of deaths was obtained from the National Center for Health Statistics (NCHS) multiple cause-of-death public use data files for the United States and Territories (including Puerto Rico) for 1999 to 2004. Deaths due to Alzheimer’s disease (ICD-10 G30) as either the underlying cause-of-death, or as one of the multiple cause-of-death listings in the entity axis format, were used in these analyses. Mortality rates were calculated using data from the US Census Bureau. Results The results showed that while all of causes of deaths had a decreasing tendency in both PR and US, the age-adjusted AD mortality rate increased in both PR and US. However, in PR the AD mortality rate (32.4/100,000; 95% CI 30.4–34.4) was higher than that observed for all US (20.9/100,000). Interestingly, the AD mortality rate of Puerto Ricans living in PR is much higher than Puerto Ricans living in the US (12.1/100,000)(p <.0001). Additionally, females had higher AD mortality rate than males in both PR and the US. Conclusions The results showed an increasing trend in AD mortality rate in both the US and PR. The higher AD mortality rate in PR versus the US could not be solely explained based on genetic factors since Puerto Ricans living in the US had lower AD mortality than those living in PR. Therefore, environmental and socioeconomic differences should be considered as contributing factors.

Alzheimer’s Disease in the Latino Community: Intersection of Genetics and Social Determinants of Health

“…Previously, we found that the mortality rate associated with AD of Puerto Ricans living in Puerto Rico is higher than that for Puerto Ricans living in the US [15]. Geographical differences in mortality rate in Puerto Rico were identified, where some regions had lower or comparable rates to that reported in the US, while other regions showed significantly higher mortality rates associated with AD [15]. The underlying causes of the differential mortality rates and clinical profiles of AD patients in Puerto Rico are still unknown.…”

“…The annual average incidence of dementia among the Mexican population in Sacramento, CA was estimated at 0.8%, while Caribbean Hispanics in North Manhattan ranged from 2.3 to 5.3% based on different studies [12–15]. Notably, a study conducted in Philadelphia showed that Latinos have more severe symptomatology associated with AD than any other ethnic group studied [16].…”

“…These results contrast to those obtained in Puerto Rico and Mexico. Studies of Puerto Ricans, living on the island of Puerto Rico, indicated that the mortality rate associated with AD is higher than their counterparts living in mainland US, but the age of onset is later and they have higher formal education than the cohorts from Philadelphia and North Manhattan [15, 20–23]. In contrast, studies in Mexico indicate that the prevalence of dementia among individuals aged 60 or older is 8% and there are over 800,000 diagnosed cases of AD [24–28].…”

Profiling of Alzheimer’s disease patients in Puerto Rico: A comparison of two distinct socioeconomic areas

“…Our previous studies of Puerto Ricans, living in the island of Puerto Rico, indicated that the mortality rate associated with AD is significantly higher than the one registered in the United States. 15 Moreover, the mortality associated with AD of Puerto Ricans in Puerto Rico is higher than that for Puerto Ricans living in the United States. 15 However, geographical analysis of mortality rate in Puerto Rico identified some regions with lower or comparable rate to the one reported in the United States, while other regions showed significantly higher mortality rate associated with AD.…”

“… 15 Moreover, the mortality associated with AD of Puerto Ricans in Puerto Rico is higher than that for Puerto Ricans living in the United States. 15 However, geographical analysis of mortality rate in Puerto Rico identified some regions with lower or comparable rate to the one reported in the United States, while other regions showed significantly higher mortality rate associated with AD. 15 The underlying cause(s) of the differential mortality rate and the clinical profile of AD patients in Puerto Rico are still unknown.…”