Racial/Ethnic Disparities in the Alzheimer's Disease Link with Cardio and Cerebrovascular Diseases, Based on Hawaii Medicare Data.
Racial/Ethnic Disparities in the Alzheimer's Disease Link with Cardio and Cerebrovascular Diseases, Based on Hawaii Medicare Data.
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DOI：
10.3233/adr-230003
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发表时间：
2023
影响因子：
3.2
通讯作者：
Chen, John J
中科院分区：
文献类型：
--
作者：
Siriwardhana, Chathura;Carrazana, Enrique;Liow, Kore;Chen, John J
有越来越多的文献表明心脏病和中风是阿尔茨海默病（AD）的危险因素。夏威夷是美国六个少数民族占多数的州之一，种族健康差异很大。夏威夷原住民/太平洋岛民（NHPI）人口是众所周知的各种疾病的高风险群体。我们根据夏威夷医疗保险数据，重点研究了心血管疾病与AD发展的关系。我们利用9年的夏威夷医疗保险数据，使用多状态模型确定发生心力衰竭（HF）、缺血性心脏病（IHD）、房颤（AF）、急性心肌梗死（AMI）、卒中和进展为AD的受试者。确定了无心血管疾病的倾向评分匹配对照组，以比较心脏病和中风后AD的风险。评估了进展为AD的种族/民族差异，考虑了其他风险因素。我们发现AF、HF、IHD和卒中的AD风险增加。社会经济（SE）地位被认为是至关重要的AD风险。在低SE组中，与亚洲人相比，在所有选定的条件下，与白人相比，在HF，IHD和卒中方面，NHPI中发现AD风险增加。有趣的是，这些观察结果在高SE组中被发现逆转，显示与AF，HF和IHD的白人以及HF和IHD的亚洲人相比，NHPI的AD风险降低。与相应的白人和亚洲人相比，SE状态较差的NHPI似乎主要因心脏/卒中和AD相关性而处于不利地位。
There is an expanding body of literature implicating heart disease and stroke as risk factors for Alzheimer’s disease (AD). Hawaii is one of the six majority-minority states in the United States and has significant racial health disparities. The Native-Hawaiians/Pacific-Islander (NHPI) population is well-known as a high-risk group for a variety of disease conditions. We explored the association of cardiovascular disease with AD development based on the Hawaii Medicare data, focusing on racial disparities. We utilized nine years of Hawaii Medicare data to identify subjects who developed heart failure (HF), ischemic heart disease (IHD), atrial fibrillation (AF), acute myocardial infarction (AMI), stroke, and progressed to AD, using multistate models. Propensity score-matched controls without cardiovascular disease were identified to compare the risk of AD after heart disease and stroke. Racial/Ethnic differences in progression to AD were evaluated, accounting for other risk factors. We found increased risks of AD for AF, HF, IHD, and stroke. Socioeconomic (SE) status was found to be critical to AD risk. Among the low SE group, increased AD risks were found in NHPIs compared to Asians for all conditions selected and compared to whites for HF, IHD, and stroke. Interestingly, these observations were found reversed in the higher SE group, showing reduced AD risks for NHPIs compared to whites for AF, HF, and IHD, and to Asians for HF and IHD. NHPIs with poor SE status seems to be mostly disadvantaged by the heart/stroke and AD association compared to corresponding whites and Asians.