Race/ethnic differences in AD survival in US Alzheimer's Disease Centers.
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.
Mehta
K M
KM
Division of Geriatrics, University of California, San Francisco, 4150 Clement St., Box 181G, San Francisco, CA 94121, USA. kala.mehta@ucsf.edu
Yaffe
K
K
Pérez-Stable
E J
EJ
Stewart
A
A
Barnes
D
D
Kurland
B F
BF
Miller
B L
BL
D001741:Black or African American; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000208:ethnology* / Q000235:genetics* / Q000401:mortality; D001057:Apolipoproteins E / Q000235:genetics; D001344:Autopsy; D001921:Brain / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D015331:Cohort Studies; D019992:Databases as Topic; D005006:Ethnicity / Q000235:genetics* / Q000706:statistics & numerical data*; D005260:Female; D005820:Genetic Testing; D006630:Hispanic or Latino; D006801:Humans; D007198:Indians, North American; D008297:Male; D015233:Models, Statistical; D058225:Plaque, Amyloid / Q000235:genetics / Q000378:metabolism / Q000473:pathology; D044469:Racial Groups / Q000208:ethnology / Q000235:genetics* / Q000706:statistics & numerical data*; D012042:Registries; D017678:Sex Distribution; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology; D044465:White People
D001057:Apolipoproteins E