Racial and socioeconomic influences on the interplay between Alzheimer's disease-related dementia and cardio-cerebrovascular disease in an aging population
Restricted accessResearch articleFirst published online August, 2025
Racial and socioeconomic influences on the interplay between Alzheimer's disease-related dementia and cardio-cerebrovascular disease in an aging population
Cardio and cerebrovascular disease (CVD) and Alzheimer's Disease-Related Dementia (ADRD) significantly impact older adult populations, with interlinked pathways influencing risk and progression. In Hawaii, where over 20% of the population is 65 or older and ethnic diversity is among the highest in the U.S., the relationship between ADRD and CVD requires closer examination, especially concerning racial and socioeconomic factors.
Objective
This study aims to assess the effects of race, ethnicity, and socioeconomic status on the bidirectional risk pathways between ADRD and CVD among older populations in Hawaii.
Methods
Utilizing a multistate modeling framework, we analyzed nine years of longitudinal Medicare data to track transitions between ADRD, CVD, and mortality outcomes. We investigated associations among racial and ethnic groups, including Native Hawaiian and other Pacific Islander (NHPI), Asian Americans (AA) and white populations, accounting for socioeconomic status to identify disparities in risk progression and outcomes.
Results
The analysis revealed notable racial and socioeconomic disparities in the transitions between ADRD, heart disease (HD), Stroke, and mortality among Hawaii's older population. Overall, lower socioeconomic status indicates increased risks for transitioning to more severe clinical states and mortality. However, such effects were found to be varied among races: AA, NHPI, and whites. Our findings suggest that socioeconomic status modifies the ADRD, HD, Stroke progression dynamics across different ethnicities.
Conclusions
This study highlights the significant role of race/ethnicity and socioeconomic status in the complex progression of ADRD and CVD.
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