Sage Journals: Discover world-class research

Abstract

Objective

To explore ADRD prevalence by nativity, comparing U.S.-born and non-U.S.-born Black individuals to uncover risk factor differences and inform targeted interventions.

Methods

We conducted a retrospective cohort study with 77,069 Black individuals from the All of Us Research Program. We analyzed two cohorts, U.S.-born and non-U.S.-born Black individuals with ADRD, using 1:1 propensity score matching to balance key factors. Analyses were performed in R and Python with significance set at α = 0.05.

Results

Of 72,311 U.S.-born and 4,758 non-U.S.-born Black individuals, 1:1 propensity score matching resulted in 4,758 matched participants per group. ADRD prevalence was 3.76% in U.S.-born and 4.12% in non-U.S.-born Blacks, with rates increasing with age and being higher among retirees and the unemployed.

Conclusion

Non-U.S.-born Black individuals have a higher ADRD risk than U.S.-born Blacks due to SDOH and demographic factors, supporting the need for targeted interventions and further research to address health inequities.

Keywords

Alzheimer’s disease and related dementias ADRD Black social determinants of health health equity nativity

Get full access to this article

View all access options for this article.

References

All of Us Research . (2024). Data snapshots. https://www.researchallofus.org/data-tools/data-snapshots/

All of Us Research Hub . (2024). Jupyter notebooks and programming. https://support.researchallofus.org/hc/en-us/articles/360039690191-Jupyter-Notebooks-and-programming

All of Us Research, P . (2026). Data access tiers. National Institutes of Health. https://www.researchallofus.org/data-tools/data-access/

Alzheimer’s

Association.

(2025). 2025 Alzheimer’s disease facts and figures. Alzheimer’s & Dementia, 21(4), e70235. https://doi.org/10.1002/alz.70235

Antecol

Bedard

(2006). Unhealthy assimilation: Why do immigrants converge to American health status levels? Demography, 43(2), 337–360. https://doi.org/10.1353/dem.2006.0011. https://www.jstor.org/stable/4137201

Aranda

M. P.

Kremer

I. N.

Hinton

Zissimopoulos

Whitmer

R. A.

Hummel

C. H.

Trejo

Fabius

(2021). Impact of dementia: Health disparities, population trends, care interventions, and economic costs. Journal of the American Geriatrics Society, 69(7), 1774–1783. https://doi.org/10.1111/jgs.17345

Austin

P. C.

(2009). Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity‐score matched samples. Statistics in Medicine, 28(25), 3083–3107. https://doi.org/10.1002/sim.3697

Austin

P. C.

(2011). An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behavioral Research, 46(3), 399–424. https://doi.org/10.1080/00273171.2011.568786

Banaji

M. R.

Fiske

S. T.

Massey

D. S.

(2021). Systemic racism: Individuals and interactions, institutions and society. Cognitive Research: Principles and Implications, 6(1), 82. https://doi.org/10.1186/s41235-021-00349-3

10.

CDC National Center for Health Statistics . (2024). International classification of diseases, Tenth Revision (ICD-10). CDC National Center for Health Statistics.

11.

Chiao

C. Y.

H. S.

Hsiao

C. Y.

(2015). Caregiver burden for informal caregivers of patients with dementia: A systematic review. International Nursing Review, 62(3), 340–350. https://doi.org/10.1111/inr.12194

12.

Cobb

C. L.

Martínez

C. R.

Lee

T. K.

Lorenzo-Blanco

E. I.

(2021). Acculturation trajectories differ by youth age at arrival and time in residency among Latino immigrant families in a US emerging immigrant context. International Journal of Intercultural Relations, 81, 79–93. https://doi.org/10.1016/j.ijintrel.2021.01.005

13.

Corra

M. K.

Borch

(2014). Socioeconomic differences among Blacks in America: Over time trends. Race and Social Problems, 6(2), 103–119. https://doi.org/10.1007/s12552-014-9114-5

14.

Denny

J. C.

Rutter

J. L.

Goldstein

D. B.

Philippakis

Smoller

J. W.

Jenkins

Bottinger

E. P.

Dishman

(2019). The “All of Us” research program. The New England Journal of Medicine, 381(7), 668–676. https://doi.org/10.1056/NEJMsr1809937

15.

Derr

A. S.

(2016). Mental health service use among immigrants in the United States: A systematic review. Psychiatric Services, 67(3), 265–274. https://doi.org/10.1176/appi.ps.201500004

16.

Franklin

J. M.

Rassen

J. A.

Ackermann

Bartels

D. B.

Schneeweiss

(2014). Metrics for covariate balance in cohort studies of causal effects. Statistics in Medicine, 33(10), 1685–1699. https://doi.org/10.1002/sim.6058

17.

Gao

Hendrie

H. C.

Hall

K. S.

Hui

(1998). The relationships between age, sex, and the incidence of dementia and Alzheimer disease: A meta-analysis. Archives of General Psychiatry, 55(9), 809–815. https://doi.org/10.1001/archpsyc.55.9.809

18.

Garcia

M. A.

Ortiz

Arévalo

S. P.

Diminich

E. D.

Briceño

Vega

I. E.

Tarraf

(2020). Age of migration and cognitive function among older Latinos in the United States. Journal of Alzheimer’s Disease, 76(4), 1493–1511. https://doi.org/10.3233/jad-191296

19.

Geronimus

A. T.

Hicken

Keene

Bound

(2006). “Weathering” and age patterns of allostatic load scores among Blacks and Whites in the United States. American Journal of Public Health, 96(5), 826–833. https://doi.org/10.2105/ajph.2004.060749

20.

Gilligan

A. M.

Malone

D. C.

Warholak

T. L.

Armstrong

E. P.

(2012). Racial and ethnic disparities in Alzheimer’s disease pharmacotherapy exposure: An analysis across four state medicaid populations. American Journal of Geriatric Pharmacotherapy, 10(5), 303–312. https://doi.org/10.1016/j.amjopharm.2012.09.002

21.

Guilliams,

T.G.

Edwards,

(2010). Chronic stress and the HPA axis: Clinical assessment and therapeutic considerations. The Standard, 9(2), 1–11.

22.

Hacker

Anies

Folb

B. L.

Zallman

(2015). Barriers to health care for undocumented immigrants: A literature review. Risk Management and Healthcare Policy, 8, 175–183. https://doi.org/10.2147/rmhp.S70173

23.

Hamilton

T. G.

(2014). Selection, language heritage, and the earnings trajectories of Black immigrants in the United States. Demography, 51(3), 975–1002. https://doi.org/10.1007/s13524-014-0298-5

24.

Hamilton

T. G.

(2020). Black immigrants and the changing portrait of Black America. Annual Review of Sociology, 46(1), 295–313. https://doi.org/10.1146/annurev-soc-121919-054728

25.

Hamilton

T. G.

Hummer

R. A.

(2011). Immigration and the health of U.S. Black adults: Does country of origin matter? Social Science & Medicine, 73(10), 1551–1560. https://doi.org/10.1016/j.socscimed.2011.07.026

26.

Hill

Rodriguez

D. X.

McDaniel

P. N.

(2021). Immigration status as a health care barrier in the USA during COVID-19. Journal of Migration and Health, 4(1), 100036. https://doi.org/10.1016/j.jmh.2021.100036

27.

Hirschman

(2014). Immigration to the United States: Recent trends and future prospects. Malaysian Journal of Economic Studies, 51(1), 69–85. https://pmc.ncbi.nlm.nih.gov/articles/PMC4302270/.

28.

Ifatunji

M. A.

Faustin

Lee

Wallace

(2022). Black nativity and health disparities: A research paradigm for understanding the social determinants of health. International Journal of Environmental Research and Public Health, 19(15), 9166. https://doi.org/10.3390/ijerph19159166

29.

Joshi

Hendrie

Jester

D. J.

Dasarathy

Lavretsky

B. S.

Leutwyler

Torous

Jeste

D. V.

Tampi

R. R.

(2024). Social connections as determinants of cognitive health and as targets for social interventions in persons with or at risk of Alzheimer's disease and related disorders: A scoping review. International Psychogeriatrics, 36(2), 92–118. https://doi.org/10.1017/s1041610223000923

30.

Kennedy

Kidd

M. P.

McDonald

J. T.

Biddle

(2015). The healthy immigrant effect: Patterns and evidence from four countries. Journal of International Migration and Integration, 16(2), 317–332. https://doi.org/10.1007/s12134-014-0340-x

31.

Kimonides

V. G.

Khatibi

N. H.

Svendsen

C. N.

Sofroniew

M. V.

Herbert

(1998). Dehydroepiandrosterone (DHEA) and DHEA-sulfate (DHEAS) protect hippocampal neurons against excitatory amino acid-induced neurotoxicity. Proceedings of the National Academy of Sciences of the United States of America, 95(4), 1852–1857. https://doi.org/10.1073/pnas.95.4.1852

32.

Kindratt

T. B.

Zahodne

L. B.

Dallo

F. J.

Ajrouch

K. J.

(2024). Alzheimer’s disease and related dementias diagnosis in the United States among US-born and foreign-born White, Black, Hispanic, and Asian older adults. Journal of Racial and Ethnic Health Disparities, 12(3), 1847–1855. https://doi.org/10.1007/s40615-024-02014-z

33.

Kline

Luo

(2022). PsmPy: A package for retrospective cohort matching in python. Annual International Conference of the IEEE Engineering in Medicine & Biology Society (EMBC), 2022, 1354–1357. https://doi.org/10.1109/EMBC48229.2022.9871333

34.

Lin

P.-J.

Daly

A. T.

Olchanski

Cohen

J. T.

Neumann

P. J.

Faul

J. D.

Fillit

H. M.

Freund

K. M.

(2021). Dementia diagnosis disparities by race and ethnicity. Medical Care, 59(8), 679–686. https://doi.org/10.1097/MLR.0000000000001577

35.

Manly

J. J.

Jones

R. N.

Langa

K. M.

Ryan

L. H.

Levine

D. A.

McCammon

Heeringa

S. G.

Weir

(2022). Estimating the prevalence of dementia and mild cognitive impairment in the US: The 2016 health and retirement study harmonized cognitive assessment protocol project. JAMA Neurology, 79(12), 1242–1249. https://doi.org/10.1001/jamaneurol.2022.3543

36.

Matthews

K. A.

Gaglioti

A. H.

Holt

J. B.

Croft

J. B.

Mack

McGuire

L. C.

(2019). Racial and ethnic estimates of Alzheimer’s disease and related dementias in the United States (2015–2060) in adults aged ≥65 years. Alzheimer’s & Dementia, 15(1), 17–24. https://doi.org/10.1016/j.jalz.2018.06.3063

37.

Mayeda

E. R.

Glymour

M. M.

Quesenberry

C. P.

Whitmer

R. A.

(2016). Inequalities in dementia incidence between six racial and ethnic groups over 14 years. Alzheimers Dementia, 12(3), 216–224. https://doi.org/10.1016/j.jalz.2015.12.007

38.

McEwen

B. S.

Stellar

(1993). Stress and the individual: Mechanisms leading to disease. Archives of Internal Medicine, 153(18), 2093–2101. https://doi.org/10.1001/archinte.1993.00410180039004

39.

Meyer

O. L.

Eng

C. W.

M. J.

Chan

M. L.

Ngo

Gilsanz

Glymour

M. M.

Mayeda

E. R.

Mungas

D. M.

Whitmer

R. A.

(2023). Generation and age of immigration on later life cognitive performance in KHANDLE. International Psychogeriatrics, 35(1), 17–28. https://doi.org/10.1017/S1041610220003774

40.

Moon

Badana

A. N. S.

Hwang

S.-Y.

Sears

J. S.

Haley

W. E.

(2019). Dementia prevalence in older adults: Variation by race/ethnicity and immigrant status. The American Journal of Geriatric Psychiatry, 27(3), 241–250. https://doi.org/10.1016/j.jagp.2018.11.003

41.

Nam

(2011). Welfare reform and immigrants: Noncitizen eligibility restrictions, vulnerable immigrants, and the social service providers. Journal of Immigrant & Refugee Studies, 9(1), 5–19. https://doi.org/10.1080/15562948.2010.522467

42.

National Academies of Sciences, E., & Medicine . (2015). The integration of immigrants into American society. The National Academies Press. https://doi.org/10.17226/21746

43.

Nichols

Szoeke

C. E. I.

Vollset

S. E.

Abbasi

Aichour

M. T. E.

Akinyemi

R. O.

Asgedom

S. W.

Awasthi

Barker-Collo

S. L.

Baune

B. T.

Béjot

Belachew

A. B.

Bennett

D. A.

Biadgo

Bin Sayeed

M. S.

Brayne

Carpenter

D. O.

Carvalho

Cerin

Murray

C. J. L.

(2019). Global, regional, and national burden of Alzheimer’s disease and other dementias, 1990–2016: A systematic analysis for the global burden of disease study 2016. Lancet Neurology, 18(1), 88–106. https://doi.org/10.1016/S1474-4422(18)30403-4

44.

Nmezi

N. A.

Turkson-Ocran

R. A.

Tucker

C. M.

Commodore-Mensah

(2022). The associations between depression, acculturation, and cardiovascular health among African immigrants in the United States. International Journal of Environmental Research and Public Health, 19(11), 6658. https://doi.org/10.3390/ijerph19116658

45.

Ormiston

C. K.

Lopez

Ishino

F. A. M.

McNeel

T. S.

Williams

(2022). Acculturation and depression are associated with short and long sleep duration among Mexican Americans in NHANES 2005–2018. Preventive Medicine Reports, 29, 101918. https://doi.org/10.1016/j.pmedr.2022.101918

46.

Penninkilampi

Casey

A. N.

Singh

M. F.

Brodaty

(2018). The Association between social engagement, loneliness, and risk of dementia: A systematic review and meta-analysis. Journal of Alzheimer’s Disease, 66(4), 1619–1633. https://doi.org/10.3233/jad-180439

47.

Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (1996) . Pub. L. No. 104-193, 110 Stat. 2105. https://www.congress.gov/bill/104th-congress/house-bill/3734

48.

Petersen

R. C.

Caracciolo

Brayne

Gauthier

Jelic

Fratiglioni

(2014). Mild cognitive impairment: A concept in evolution. Journal of Internal Medicine, 275(3), 214–228. https://doi.org/10.1111/joim.12190

49.

Power

M. C.

Bennett

E. E.

Turner

R. W.

Dowling

N. M.

Ciarleglio

Glymour

M. M.

Gianattasio

K. Z.

(2021). Trends in relative incidence and prevalence of dementia across non-Hispanic Black and White individuals in the United States, 2000-2016. JAMA Neurology, 78(3), 275–284. https://doi.org/10.1001/jamaneurol.2020.4471

50.

Rajan

K. B.

Weuve

Barnes

L. L.

McAninch

E. A.

Wilson

R. S.

Evans

D. A.

(2021). Population estimate of people with clinical Alzheimer’s disease and mild cognitive impairment in the United States (2020-2060). Alzheimers Dementia, 17(12), 1966–1975. https://doi.org/10.1002/alz.12362

51.

Rosenbaum

P. R.

Rubin

D. B.

(1983). The central role of the propensity score in observational studies for causal effects. Biometrika, 70(1), 41–55. https://doi.org/10.1093/biomet/70.1.41

52.

Samtani

Mahalingam

Lam

B. C. P.

Lipnicki

D. M.

Lima-Costa

M. F.

Blay

S. L.

Castro-Costa

Shifu

Guerchet

Preux

P. M.

Gbessemehlan

Skoog

Najar

Rydberg Sterner

Scarmeas

Kim

K. W.

Riedel-Heller

Röhr

Pabst

Brodaty

(2022). Associations between social connections and cognition: A global collaborative individual participant data meta-analysis. Lancet Healthy Longevity, 3(11), e740–e753. https://doi.org/10.1016/s2666-7568(22)00199-4

53.

Smiti

(2020). A critical overview of outlier detection methods. Computer Science Review, 38(1), 100306. https://doi.org/10.1016/j.cosrev.2020.100306

54.

Tamir

(2022). Key findings about Black immigrants in the US. https://www.pewresearch.org/short-reads/2022/01/27/key-findings-about-black-immigrants-in-the-u-s/

55.

The World Bank . (2024). Propensity score matching. https://dimewiki.worldbank.org/Propensity_Score_Matching

56.

Urzúa

Caqueo-Urízar

Henríquez

Williams

D. R.

(2021). Discrimination and health: The mediating effect of acculturative stress. International Journal of Environmental Research and Public Health, 18(10), 5312. https://doi.org/10.3390/ijerph18105312

57.

Van Hook

Glick

J. E.

(2020). Spanning borders, cultures, and generations: A decade of research on immigrant families. Journal of Marriage and Family, 82(1), 224–243. https://doi.org/10.1111/jomf.12621

58.

Wang

J. T.

Ren

R. J.

Wang

Tang

Huang

J. P.

Al‐Nusaif

W. D.

Wang

(2023). The impacts of health insurance and resource on the burden of Alzheimer’s disease and related dementias in the world population. Alzheimer’s & Dementia, 19(3), 967–979. https://doi.org/10.1002/alz.12730

59.

Wang

Cai

Jiang

Wang

Song

Xia

(2013). Optimal caliper width for propensity score matching of three treatment groups: A monte carlo study. PloS One, 8(12), Article e81045. https://doi.org/10.1371/journal.pone.0081045

60.

Williams

D. R.

Mohammed

S. A.

Leavell

Collins

(2010). Race, socioeconomic status, and health: Complexities, ongoing challenges, and research opportunities. Annals of the New York Academy of Sciences, 1186(1), 69–101. https://doi.org/10.1111/j.1749-6632.2009.05339.x

61.

Woo

Fan

Tran

T. V.

Takeuchi

D. T.

(2019). The role of racial/ethnic identity in the association between racial discrimination and psychiatric disorders: A buffer or exacerbator? SSM - Population Health, 7, 100378. https://doi.org/10.1016/j.ssmph.2019.100378

62.

Y. T.

Beiser

A. S.

Breteler

M. M. B.

Fratiglioni

Helmer

Hendrie

H. C.

Honda

Ikram

M. A.

Langa

K. M.

Lobo

Matthews

F. E.

Ohara

Pérès

Qiu

Seshadri

Sjölund

B. M.

Skoog

Brayne

(2017). The changing prevalence and incidence of dementia over time - Current evidence. Nature Reviews Neurology, 13(6), 327–339. https://doi.org/10.1038/nrneurol.2017.63

63.

Zhang

(2017). Association between migration and cognitive status among middle-aged and older adults: A systematic review. BMC Geriatrics, 17(1), 184. https://doi.org/10.1186/s12877-017-0585-2

64.

Zhang

Kim

H. J.

Lonjon

Zhu

(2019). Balance diagnostics after propensity score matching. Annals of Translational Medicine, 7(1), 16. https://doi.org/10.21037/atm.2018.12.10.

Alzheimer’s Disease and Related Dementia Among Black Adults Stratified by Nativity

Abstract

Objective

Methods

Results

Conclusion

Keywords

Get full access to this article

References