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Race/ethnic differences in AD survival in US Alzheimer's Disease Centers

From the Division of Geriatrics (K.M.M.), Department of Psychiatry (K.Y., D.B., B.L.M.), Department of Neurology (K.Y., B.L.M.), Department of Epidemiology (K.Y.), Division of General Internal Medicine, Department of Medicine (E.J.P.-S.), Institute for Health and Aging (A.S.), and Medical Effectiveness Research Center for Diverse Populations (K.M.M., E.J.P.-S., A.S.), University of California, San Francisco, CA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA (B.F.K.); and San Francisco Veterans Affairs Medical Center, San Francisco, CA (K.M.M., K.Y., D.B.).

Address correspondence and reprint requests to Dr. Kala M. Mehta, Division of Geriatrics, University of California, San Francisco, 4150 Clement St., Box 181G, San Francisco, CA 94121 kala.mehta{at}ucsf.edu.

Objective: Survival after Alzheimer disease (AD) is poorly understood for patients of diverse race/ethnic groups. We examined whether nonwhite AD patients (African American, Latino, Asian, American Indian) had different rates of survival compared with white AD patients.

Methods: The National Alzheimer's Coordinating Center (NACC) cataloged data from more than 30 Alzheimer's Disease Centers in the United States from 1984 to 2005. Patients aged 65 years or older with a diagnosis of possible/probable AD were included (n = 30,916). Survival was calculated using Cox proportional hazards models with a primary outcome of time to death. Secondary outcomes of this study were neuropathologic characteristics on an autopsied subsample (n = 3,017).

Results: The 30,916 AD patients in the NACC were followed up for 2.4 ± 2.9 years (mean age 77.6 ± 6.5 years; 65% women; 19% nonwhite [12% African American, 4% Latino, 1.5% Asian, 0.5% American Indian, and 1% other]). Median survival was 4.8 years. African American and Latino AD patients had a lower adjusted hazard for mortality compared with white AD patients (African American hazard ratio [HR] 0.85, 95% CI 0.74 to 0.96; Latino HR 0.57, 95% CI 0.46 to 0.69). Asians and American Indians had similar adjusted hazards for mortality compared with white AD patients (p > 0.10 for both). African American and Latino autopsied AD patients had similar neuropathologic characteristics compared with white AD patients with similar clinical severity.

Conclusions: African American and Latino Alzheimer disease (AD) patients may have longer survival compared with white AD patients. Neuropathology findings did not explain survival differences by race. Determining the underlying factors behind survival differences may lead to longer survival for AD patients of all race/ethnic backgrounds.

Abbreviations: AD = Alzheimer disease; ADC = Alzheimer's Disease Center; HR = hazard ratio; MMSE = Mini-Mental State Examination; NACC = National Alzheimer's Coordinating Center; NIA = National Institute on Aging; OR = odds ratio.

e-Pub ahead of print on November 14, 2007, at www.neurology.org.

*These authors contributed equally as senior coauthors of this article.

Editorial, page 1158.

Dr. Mehta is currently supported by a Research Career Scientist Award from the National Institute on Aging (NIA-K-01AG025444-01A1) and a junior investigator award from the National Alzheimer's Coordinating Center (#2005-JI-11). She is currently an affiliate of the Center for Aging in Diverse Communities at UCSF, a part of the P30 AG 15272 Resource Centers for Minority Aging Research Program (National Institute of Nursing Research, and the National Center for Minority Health and Health Disparities). The University of California, San Francisco Alzheimer's Disease Research Center is supported through ADRC (P50-AG023501). The National Alzheimer's Coordinating Center is supported by National Institute on Aging grant U01AG016976.

Disclosure: The authors report no conflicts of interest.

Received April 27, 2007. Accepted in final form July 23, 2007.

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