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ARTICLES: K. M. Mehta, K. Yaffe, E. J. Pérez-Stable, A. Stewart, D. Barnes, B. F. Kurland, and B. L. Miller Race/ethnic differences in AD survival in US Alzheimer's Disease Centers Neurology 2008; 70: 1163-1170 [Abstract] [Full text] [PDF]

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

Daniel Ontaneda   (15 August 2008)

Reply from the authors

Kala M. Mehta, D.Sc., MPH, Eliseo Perez-Stable, MD   (15 August 2008)

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

Douglas J. Lanska   (18 June 2008)

Reply from the author

Kala Mehta   (18 June 2008)

Race/ethnic differences in AD survival in US Alzheimer's Disease Centers 15 August 2008
Daniel Ontaneda, Cleveland Clinic 9500 Euclid Avenue S100 Cleveland, Ohio 44195 Send Correspondence to journal: Re: Race/ethnic differences in AD survival in US Alzheimer's Disease Centers ontaned{at}ccf.org Daniel Ontaneda	I read with interest the article published by Mehta et al. on race/ethnic differences in Alzheimer's disease (AD). [1] Race/Ethnicity was classified as Latino, non-Latino who were White, African American, Asian/Pacific Islander (Asian), American Indian, and people of other or unknown race. This classification stems from a governmental designation of race and ethnicity. [2] Within each of these racial/ethnic groups there is tremendous genetic and cultural heterogeneity due to the heterogeneous extraction of racial/ethnic groups in the US. These differences may obscure possible conclusions regarding the finding that African American and Latino populations have longer survival compared to White populations with AD. Further details regarding the Latino/Hispanic subjects are not included in the text. The racial make-up of this group is unclear (i.e., African-American, Mulatto, Mestizo, Native American, Caucasian). Given our multi-cultural society, we should strive to use more precise markers of genotypic, cultural, and social factors in the investigation of disease. [3] References 1. Mehta KM, Yaffe K, Perez-Stable EJ al. Race/ethnic differences in AD survival in US alzheimer's disease centers. Neurology. 2008;70:1163-1170. 2. Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity (October 30, 1997): Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity. United States Office of Management and Budget, Accessed On-line on April 7, 2008. 3. Ellison GT, Smart A, Tutton R, Outram SM, Ashcroft R, Martin P. Racial categories in medicine: A failure of evidence-based practice? PLoS Med. 2007;4:e287. Disclosures: The author has no disclosures.
Reply from the authors 15 August 2008
Kala M. Mehta, D.Sc., MPH, University of California, San Francisco , Eliseo Perez-Stable, MD Send Correspondence to journal: Re: Reply from the authors kala.mehta{at}ucsf.edu Kala M. Mehta, D.Sc., MPH, et al.	We agree with Dr. Ontaneda that each mutually-exclusive race/ethnic group used in our study may contain a tremendous amount of genetic and cultural heterogeneity. Our study utilized existing data that was catalogued to the National Alzheimer’s Coordinating Center. Using the US Census questions, Hispanic/Latino ethnicity is asked first since the assumption is that Latinos can be of any race. In this data set, 66% of the individuals who were of ‘Hispanic’ ethnicity were categorized as ‘Other’ race, 30% were of ‘White’ race, 3% were of ‘Black’ race and less than 1% were of ‘Asian’ or ‘American Indian’ race. National data would indicate that the proportion who self-categorize as White is closer to 50% and about 40% are of Other Race probably reflecting the admixed nature of the Latino population. Our study reported data on all Latino individuals, those who were of Hispanic ethnicity and of any race category together. We did not have information on whether subjects were Mulatto (mixed White and Black race) or Mestizo (mixed White and Indigenous). Future studies with race/ethnicity as a focus should strive to disaggregate race/ethnic groups as much as possible to reflect genetic, cultural, and social diversity within any broad categorizations of race. However, there is a risk that further disaggregating the categories will lead to such small number that little can be concluded about any of the groups. Available genetic data actually supports the geographic origin of race in the categories used by the US Census. Furthermore, the Latino/Hispanic population has been admixed for 500 years and resulted in a unique population group that merits separate category from a genetic perspective. From a cultural and social perspective, there is ample evidence that Latinos/Hispanics share more common characteristics as an immigrant group in the US than differences rooted in national origin and racial admixture. The US Census categorization is legitimate and facilitates analyses of available data such as ours. Further disaggregating the sample by national origin and type of racial admixture would be useful adjuncts to these analyses but should not replace these categories. Disclosure: 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. Dr. Perez-Stable reports no disclosures.
Race/ethnic differences in AD survival in US Alzheimer's Disease Centers 18 June 2008
Douglas J. Lanska, VA Medical Center 500 E. Veterans St., Tomah, WI 54660 Send Correspondence to journal: Re: Race/ethnic differences in AD survival in US Alzheimer's Disease Centers Douglas.Lanska{at}med.va.gov Douglas J. Lanska	Mehta and colleagues [1] incorrectly summarized the findings of my article on dementia mortality in the US by suggesting that “African American patients of the same age have shorter survival times.” [2] However, my study presented nationally representative, age-adjusted, race- and gender-specific estimates of dementia mortality rates based on different means of ascertainment, rather than survival rates of those with dementia. Disease-specific mortality rates are an estimate of the proportion of a population that dies from or with the condition during a specified period, while survival rates are the proportion of survivors in a group (e.g., with dementia) who are studied and followed over a period of time. My study utilized the 1986 National Mortality Followback Survey, which was based on a nationwide probability sample of persons aged 25 and over who died in the United States in 1986. For sampled decedents, information was obtained from multiple sources including death certificates, detailed questionnaires, and interviews of family members conducted by the U.S. Bureau of the Census, and from abstracted records of health facilities that provided care during the last year of life. Mortality rates varied widely depending on the method of ascertainment to a much greater degree than differences across race or gender. Moreover, there was an interaction between race and the method of ascertainment: blacks had lower mortality rates than whites when ascertainment was based on either facility diagnoses or death certificates. However, blacks had higher rates than whites when based on informant-reported physician diagnoses of Alzheimer disease or any other serious memory impairment during life. References 1. Mehta KM, Yaffe K, Pérez-Stable EJ, et al. Race/ethnic differences in AD survival in US Alzheimer’s Disease Centers. Neurology 2008;70:1163-1170. 2. Lanska DJ. Dementia mortality in the United States: Results of the 1986 National Mortality Followback Survey. Neurology 1998;50:362-367. Disclosure: The author reports no disclosures.
Reply from the author 18 June 2008
Kala Mehta, Center on Aging, University of California, San Francisco 3333 California Street, Suite 380, San Francisco California, 94403 Send Correspondence to journal: Re: Reply from the author Kala.Mehta{at}ucsf.edu Kala Mehta	We appreciate Dr. Lanska's correction and comments regarding his article entitled "Dementia mortality in the United States. Results of the 1986 National Mortality Followback Survey". [2] We would like to emphasize Dr. Lanska's point that the mortality rates calculated in his paper and the survival rates in our paper are not directly comparable. Mortality rates are an important measure of disease burden for a population. As stated by Dr. Lanska, the mortality rates in this article differed to a greater degree by method of ascertainment than by race. Future work that calculates various epidemiologic measures of disease burden, including disease-specific mortality rates and survival rates for diverse race/ethnic groups are needed to thoroughly capture the impact of dementia on mortality for diverse older adults. Disclosure: The author reports no disclosures.