Exacerbating Inequities: The Impact of ADRD and COVID-19
Older adults with Alzheimer's disease and related dementias (ADRD) represent a particularly vulnerable population during the COVID-19 pandemic due to cognitive decline, comorbidities, and reliance on caregiving. Significant racial and ethnic disparities were observed in COVID-19 outcomes for this group, highlighting the need to address systemic inequities. While some risk factors like age and gender are universal, their impact is shaped by race, ethnicity, and social determinants of health.
Individual-Level Risk Factors and Variations
Individual health factors contributing to severe COVID-19 outcomes vary among racial and ethnic groups with ADRD. Medicare data analysis revealed differences in comorbidities and dual-eligibility status. Black and Hispanic older adults with ADRD often had higher rates of conditions like diabetes, hypertension, and chronic kidney disease compared to White individuals. These conditions are known risk factors for severe COVID-19.
Prevalence of Chronic Conditions
- Chronic Kidney Disease: More prevalent among Black and Hispanic older adults with ADRD.
- Diabetes and Obesity: Also more common in minority populations and increase COVID-19 severity.
- Hypertension: A key risk factor with varying prevalence among groups.
Prior Healthcare Utilization
Data also indicated differences in prior healthcare use, with higher rates of nursing home stays or hospitalizations among Black individuals with ADRD in some analyses, suggesting potentially poorer baseline health.
Systemic and Structural Factors
Beyond individual health, structural racism and social determinants of health significantly influenced outcomes during the pandemic.
Social Determinants of Health
Systemic inequality impacted health in older adults with ADRD:
- Lower Socioeconomic Status (SES): Black and Hispanic individuals were more likely to be dual Medicare-Medicaid eligible, indicating lower income and factors linked to poorer health outcomes.
- Segregated Living Environments: Minority older adults with ADRD often lived in disadvantaged communities or nursing homes with fewer resources and higher vulnerability to outbreaks, impacting mortality.
- Vaccination Hesitancy and Mistrust: Lower vaccination rates in some Black communities, potentially due to historical mistrust from systemic racism, may have contributed to persistent mortality disparities.
Access to Quality Care
Differences in healthcare access and quality also worsened disparities. Minority groups with ADRD faced barriers like language, transportation, and discrimination, potentially leading to delayed or inadequate care and worse outcomes.
Comparison of Risk Factors by Race and Ethnicity
This table highlights key differences in risk factors during the pandemic:
| Risk Factor | White Older Adults with ADRD | Black Older Adults with ADRD | Hispanic Older Adults with ADRD |
|---|---|---|---|
| Age Distribution | Tend to be older, more over 85 years. | Younger median age. | Younger median age. |
| Comorbidities | Lower rates of specific conditions like diabetes and hypertension. | Higher prevalence of diabetes, hypertension, chronic kidney disease. | Higher prevalence of certain chronic conditions. |
| SES & Dual Eligibility | Lower proportion of dual eligibility. | Higher proportion of dual-eligible status. | Higher proportion of dual-eligible status. |
| Mortality | Lower age-adjusted mortality compared to minority groups over much of the pandemic. | High excess mortality, disparities persisted. | Higher mortality, ethnic disparity reduced later in the pandemic. |
| Healthcare Access | Generally better access. | More likely to face systemic barriers. | May face language and socioeconomic obstacles. |
The Role of Disparities in COVID-19 Outcomes
COVID-19 outcomes for older adults with ADRD differed significantly by race and ethnicity. Hispanic older adults had higher odds of diagnosis, while Black and Hispanic individuals faced higher hospitalization and mortality rates compared to White individuals. These disparities persisted even when accounting for individual risk factors, indicating the impact of broader systemic inequalities.
Conclusion: Looking Beyond Individual Health
The disproportionate impact of severe COVID-19 on racial and ethnic minority older adults with ADRD underscores the need to address underlying social determinants of health and structural inequities, in addition to medical risk factors. Tailored public health interventions that consider socioeconomic status, vaccine access, and historical mistrust are crucial for achieving equitable outcomes and building a more resilient healthcare system for all vulnerable populations. Further research is needed to fully understand these complex disparities.
For more information on the impact of COVID-19 on older adults and health equity, consult authoritative sources such as the Centers for Disease Control and Prevention.
