Challenges and Considerations Related to Studying Dementia in Blacks/African Americans

Article type: Review Article

Authors: Ighodaro, Eseosa T.^{a; b; *} | Nelson, Peter T.^{a; b; c; *} | Kukull, Walter A.^d | Schmitt, Frederick A.^{b; e} | Abner, Erin L.^{b; f} | Caban-Holt, Allison^{b; g} | Bardach, Shoshana H.^{b; g} | Hord, Derrick C.^b | Glover, Crystal M.^h | Jicha, Gregory A.^{b; e} | Van Eldik, Linda J.^{a; b} | Byrd, Alexander X.ⁱ | Fernander, Anita^j

Affiliations: [a] Department of Neuroscience, University of Kentucky, Lexington, KY, USA | [b] Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA | [c] Department of Pathology and Laboratory Medicine, Division of Neuropathology, University of Kentucky, Lexington, KY, USA | [d] National Alzheimer’s Coordinating Center, Department of Epidemiology, University of Washington, Seattle, WA, USA | [e] Department of Neurology, University of Kentucky, Lexington, KY, USA | [f] Department of Epidemiology, University of Kentucky, Lexington, KY, USA | [g] Graduate Center for Gerontology, University of Kentucky, Lexington, KY, USA | [h] Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA | [i] Department of History, Rice University, Houston, Texas, USA | [j] Department of Behavioral Science, University of Kentucky, Lexington, KY, USA

Correspondence: [*] Correspondence to: Eseosa T. Ighodaro, PhD, Department of Neuroscience, Sanders-Brown Center on Aging, University of Kentucky, Sanders-Brown Center on Aging Building, 800 South Limestone, Lexington, KY 40536-0230, USA. Tel.: +1 859 218 2396; E-mail: etigho2@uky.edu and Peter T. Nelson, MD, PhD, Department of Pathology, Division of Neuropathology, Sanders-Brown Center on Aging, University of Kentucky, Sanders-Brown Center on Aging Building, 800 South Limestone, Lexington, KY 40536-0230, USA. Tel.: +1 859 218 5038; E-mail: pnels2@uky.edu.

Abstract: Blacks/African Americans have been reported to be ∼2–4 times more likely to develop clinical Alzheimer’s disease (AD) compared to Whites. Unfortunately, study design challenges (e.g., recruitment bias), racism, mistrust of healthcare providers and biomedical researchers, confounders related to socioeconomic status, and other sources of bias are often ignored when interpreting differences in human subjects categorized by race. Failure to account for these factors can lead to misinterpretation of results, reification of race as biology, discrimination, and missed or delayed diagnoses. Here we provide a selected historical background, discuss challenges, present opportunities, and suggest considerations for studying health outcomes among racial/ethnic groups. We encourage neuroscientists to consider shifting away from using biologic determination to interpret data, and work instead toward a paradigm of incorporating both biological and socio-environmental factors known to affect health outcomes with the goal of understanding and improving dementia treatments for Blacks/African Americans and other underserved populations.

Keywords: Autopsy, epidemiology, ethnicity, neurodegenerative, neuropathology

DOI: 10.3233/JAD-170242

Journal: Journal of Alzheimer's Disease, vol. 60, no. 1, pp. 1-10, 2017