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Alzheimer’s Disease

Alzheimer’s disease is a progressive neurological disorder that affects memory, thinking, and behavior. Alzheimer’s is the most common form of dementia and is often characterized into three broad phases: preclinical Alzheimer’s disease, mild cognitive impairment, and dementia [1]. Although age is the greatest known risk factor for Alzheimer’s, dementia is not a normal sign of aging.

The cause of Alzheimer’s is not fully understood, but a hallmark of the disease is abnormal buildup of amyloid plaques and tau tangles formed in the brain. This buildup contributes to brain cell atrophy and death, leading to significant impairment of an individual to function independently – intellectually, physically, and socially – as the disease progresses.

The information presented below has been curated from 2018 data, unless otherwise stated. 

Disease Burden

In 2018, of the estimated 5.5 million people ages 65 and older with Alzheimer’s in the United States, two-thirds were women [2]. Alzheimer’s was the 2nd leading cause of death for women and the 7th leading cause of death for men. Given the growing aging population in the United States, the number of people ages 65 and older with Alzheimer’s is projected to reach 13.8 million by 2060.

Older Black and older Hispanic people are 2x and 1.5x, respectively, more likely to have Alzheimer’s compared to their white counterparts [2]. Research suggests disparities in health conditions, socioeconomic status, and lived experiences may contribute to these differences.

Total health care and long-term care among Medicare beneficiaries with Alzheimer’s or other dementias reached $277 billion in 2018 [1]. The average annual Medicaid payment per person for Medicare beneficiaries with Alzheimer’s or other dementias ($8565) was 23 times greater than the those without Alzheimer’s or other dementias ($365), with incremental Medicaid costs associated with Alzheimer’s dementia 70% higher for women than men [2].

Dementia caregivers are typically family members – either spouses or adult children – and 2/3 of all dementia caregivers are women [3]. Despite the work being substantial, it is often unpaid. Approximately 18 billion hours of care, valued at nearly $235 billion, was estimated for Alzheimer’s caregivers in 2018 alone [2].

Disease Prevalence and Mortality

Alzheimer’s Disease and Other Dementias Prevalence* by Sex

Female 16%, Male 11%

*Among individuals 71 years and older
Source: 2018 Alzheimer’s Disease Facts and Figures [1]

Alzheimer’s Disease Prevalence by Age

Source: Hebert LE, et al. [4]

Alzheimer’s Disease Prevalence* by Race

Bar chart

*Prevalence of Alzheimer’s Disease and Related Dementias (ADRA) among individuals 65 years and older, 2014
**Includes Hispanic individuals of any race Source: Matthews KA, et al. [5]

Download Alzheimer’s Disease Prevalence Data (2018)

Source: CDC Wonder [6]

Alzheimer’s Disease Mortality, U.S. Females, All Ages – Top 5 States

Crude Rates are expressed as the number of deaths reported for a calendar year per 100,000 persons.
Black/AA: Black or African American; Hispanic: Hispanic or Latino; API: Asian or Pacific Islander; AI/AN: American Indian or Alaska Native
N/A: Number of deaths fall below a determined cut-off value and therefore are suppressed, and a crude rate is not calculated.
Unreliable: Death rates are flagged as unreliable when the rate is calculated with a numerator of 20 or fewer deaths.
*Includes Hispanic individuals of any race

 

Alzheimer’s Disease Mortality, U.S. Females, All Ages, by Race – Top 3 States

Black/AA: Black or African American; Hispanic: Hispanic or Latino; API: Asian or Pacific Islander; AI/AN: American Indian or Alaska Native
*Includes Hispanic individuals of any race

 

California, a large and historically diverse state, was among the top 3 states for Alzheimer’s mortality for every race/ethnicity group. High mortality rates are also widely observed across the Southern states (i.e., Alabama, Oklahoma, Mississippi, North Carolina, South Carolina).

Download the Full Data Table of Alzheimer’s Disease Mortality (2018), U.S. Females, All Ages, By Race and State

Disease Impacts and Influences

Multiple factors contribute to incidence, morbidity, and mortality for Alzheimer’s and its disproportional impact on women and women’s health, including but not limited to biological sex, sociocultural influences, and insurance coverage.

Research Investment

The National Institutes of Health funded $1.79 billion in Alzheimer’s Disease research in 2018 (6.7% of its total budget). Of the 3015 research grants funded, 29 (<1.0%) projects focused on women’s health.*

*Women’s health focus was determined by searching the following key terms – Female, Gender, Maternal, Sex, and variations of Lactating, Pregnant, Women – in the project titles of all Alzheimer’s funded grants, according to the NIH Research, Condition, and Disease Categorization (RCDC) report.

Download the Full List of 2018 Nih-Funded Grants for Alzheimer’s Disease

Health Disparities

  • Misdiagnosis of Alzheimer’s disease and other dementias is more common for Black and Hispanic people compared to their white counterparts [2].
  • Japanese Americans have the lowest reported prevalence of dementia compared to all other ethnic groups [2].

Disease Burden

According to the World Health Organization Global Health Estimates, in 2018, Alzheimer’s disease and other dementias accounted for 2,267,188 disability-adjusted life years (DALY) lost, or a total DALY Rate of 51,848 per 100,000 individuals, among women 65 years and older in the United States [7].

Insurance Coverage

There are significant financial costs associated with medical care for individuals with chronic and/or degenerative diseases such as Alzheimer’s. Health insurance access and coverage are important for assisting with the financial burden. Below is a table displaying rates of insurance coverage for the states with the 5 highest mortality rates attributed to Alzheimer’s in 2018.

U.S. Health Insurance Coverage by State

Source: Kaiser Family Foundation Health Insurance Coverage of the Total Population (CPS), 2018 [8]
Uninsured: Includes individuals without health insurance and individuals who have coverage under the Indian Health Service only.
Employer: Includes individuals covered by employer-sponsored coverage either through their own job or as a dependent in the same household.
Non-Group: Includes individuals and families that purchased or are covered as a dependent by non-group insurance.
Medicaid: Includes individuals covered by Medicaid, the Children’s Health Insurance Program (CHIP), and those who have both Medicaid and another type of coverage, such as dual eligibles who are also covered by Medicare.
Medicare: Includes individuals covered by Medicare, Medicare Advantage, and those who have Medicare and another type of non-Medicaid coverage where Medicare is the primary payer. Excludes individuals with Medicare Part A coverage only and those covered by Medicare and Medicaid (dual eligibles).
Military: Includes individuals covered under the military or Veterans Administration.
N/A: Estimates with relative standard errors greater than 30% are not provided.

Download the Full Data Table of u.s. Health Insurance Coverage (2018), by State

Caregiving Burden

  • Over 1/3 of dementia caregivers are daughters [2].
  • Caregivers who are women report higher levels of depression and worse health compared to caregivers who are men. These women are more likely to express a need for individual counseling (83% vs. 17%), respite care (72% vs. 29%), and support groups (73% vs. 27%) compared to caregivers who are men [2].

Resources and References

Additional Resources

References

12018 Alzheimer’s Disease Facts and Figures. Alzheimers Dement, 2018; 14(3):367-429.

22019 Alzheimer’s Disease Facts and Figures. Alzheimers Dement, 2019, 15(3):321-387.

3Nebel RA, Aggarwal NT, Barnes LL, et al. Understanding the Impact of Sex and Gender in Alzheimer’s Disease: A Call to Action. Alzheimers Dement, 2018; 14(9): 1171–1183.

4Hebert LE, Weuve J, Scherr PA, Evans DA. Alzheimer Disease in the United States (2010-2050) Estimated Using the 2010 Census. Neurology, 2013 May 7;80(19):1778-83.

5Matthews KA, Xu W, Gaglioti AH, et al. Racial and Ethnic Estimates of Alzheimer’s Disease and Related Dementias in the United States (2015–2060) in Adults Aged ≥65 years. Alzheimers Dement, 2019; 15(1):17–24.

6United States Department of Health and Human Services (US DHHS), Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), Underlying Cause of Death by Single Race 2018-2020 on CDC WONDER Online Database, released 2021. Data are compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Data for year 2018 are compiled from the Multiple Cause of Death File 2018, Series 20, No. 2X, 2020. Accessed at https://wonder.cdc.gov/controller/saved/D76/D282F137 Accessed 20 July 2022.

7Global Health Estimates 2020: Disease burden by Cause, Age, Sex, by Country and by Region, 2000-2019. Geneva, World Health Organization; 2020.

8Kaiser Family Foundation State Health Facts. Health Insurance Coverage of the Total Population (CPS). Data Source: Census Bureau’s March Current Population Survey (CPS: Annual Social and Economic Supplements), 2017-2022. https://www.kff.org/other/state-indicator/health-insurance-coverage-of-the-total-population-cps/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D. Accessed 14 June 2022.

Call to Action

Despite the broad investment in Alzheimer’s disease research and care, there remain significant gaps in our understanding and approach to addressing disease disparities for women. SWHR has identified priority areas to eliminate gaps in Alzheimer’s disease concerning delays in diagnoses for women, inclusion of women in clinical trials, disproportionate burden of caregiving, and policy solutions that hinder access and care for women living with Alzheimer’s disease.

View Call to Action

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