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Race but not sex differences in incidence of dementia diagnosis among older veterans
Author(s) -
Kornblith Erica S,
Peltz Carrie,
Xia Feng,
Barnes Deborah E,
Byers Amy L,
Yaffe Kristine
Publication year - 2020
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1002/alz.037606
Subject(s) - medicine , dementia , incidence (geometry) , hazard ratio , cohort , demography , cohort study , gerontology , disease , confidence interval , sociology , physics , optics
Background Although the U.S. military is increasingly diverse, the impact of sex and race on incidence of dementia diagnosis among older Veterans is unknown. Method We compared incidence of dementia diagnosis among self‐reported race groups (Non‐Hispanic White, Non‐Hispanic Black, Hispanic, and Asian) and by sex among a random sample of all Veterans > 65 years in the Veterans Health Administration between 10/1/2003 and 9/30/2015. We included Veterans without baseline prevalent dementia (over a 2‐year baseline) with > 1 visit during the follow‐up period ( < 12 years). Dementia was defined as inpatient/ outpatient diagnoses using International Classification of Disease 9 th Edition (ICD‐9) codes recommended by the VA Dementia Steering Committee, dementia medication prescription, or both. We calculated crude incidence by age, sex, and race; and conducted Cox models adjusted for age and sex/race. We further adjusted models for education, income, cardiac/metabolic, and military (post‐traumatic stress disorder, traumatic brain injury) risk factors. Result The analytic cohort included 497,127 Veterans (mean age 75.4) after excluding 18,314 with baseline dementia and 11,058 without follow‐up. About eight percent (n=40,352) were diagnosed with dementia during follow‐up. Overall incidence increased by age (50/1000 people, ages 65‐74; 112/1000 for 75‐84, and 116/1000 among 85+; p<0.001). Across all ages, males’ incidence (81/1000) was similar to females’ (77/1000; p=0.10); adjusted Hazard ratio (HR) for females vs. males: 0.96, 95% Confidence Interval (CI) 0.89‐1.03. Hispanic Veterans had highest incidence (154/1000), while Asian veterans had lowest (71/1000); incidence for white Veterans was 79/1000, and 101/1000 for Black Veterans. Compared to white Veterans, Asian Veterans had borderline lower risk of dementia diagnosis (HR: 0.87, 95% CI 0.76‐1.01), and Black (HR: 1.61, 95% CI 1.55‐1.66) and Hispanic Veterans (HR: 1.80, 1.68‐1.93) had increased risk. The pattern of results was similar after full adjustment (Hispanic HR 1.59, 95% CI 1.48‐ 1.71; Black HR 1.49, 95% CI 1.44‐1.54; Asian HR 0.89, 95% CI 0.77‐1.04). Conclusion Among older U.S. Veterans, there were differences in incidence of dementia diagnosis by race: Black and Hispanic Veterans had almost two‐fold greater risk compared to white Veterans. Asian Veterans had lower risk. Females and males had similar incidence. These results highlight health disparities requiring further study.