Baltimore has one of the highest rates of Alzheimer’s disease in the country and Maryland has the highest rate among states, according to an analysis published in the Alzheimer’s Association’s online journal.
Roughly 16.6% of the 87,800 Baltimore residents who are 65 years or older are estimated to have the neurodegenerative disease, according to the study’s findings. The city tied for the highest prevalence of Alzheimer’s disease among the 3,142 jurisdictions included in the study, all of which have more than 10,000 residents 65 or older.
In Florida’s Miami-Dade County and New York’s Bronx County, 16.6% of residents 65 or older are also estimated to have Alzheimer’s, the study found. Prince George’s County ranked second in the U.S., with an estimated prevalence of 16.1%.
Overall, Maryland has an estimated 12.9% prevalence, ahead of New York, which has a 12.7% prevalence.
Jim Macgill, assistant commissioner of Aging and CARE Services for the Baltimore City Health Department, eagerly awaited the report published Monday after learning last week of its impending release. While there is a lot of national data available about Alzheimer’s — including that it is twice as common among older African Americans than white people and 1.5 times more common among Hispanics — there’s a paucity of local data, he said.
Macgill said he was surprised to see how highly Baltimore ranked. But he and others who work with seniors in Baltimore pointed to an accumulation of many health disparities in the city — tied to its history of segregation in housing and other areas — as one likely reason for its high rate of Alzheimer’s disease.
“Not only is Baltimore City a majority Black city, but it’s a city where certain neighborhoods traditionally have been the victim of disparities and inequities,” Macgill said. “Up to now, I don’t think people have seen Alzheimer’s disease as linked to those inequities, the way they’ve seen maybe other health care issues. But I think increasingly, we’re going to find that.”
Kumar Rajan, one of the authors of the report, also pointed to the racial breakdown of a county’s population as a factor that could explain why some had higher estimated rates of Alzheimer’s than others. The average age of a county’s population could further explain the pattern, he said. About 32% of Maryland’s population is Black, according to the U.S. Census Bureau. For Baltimore, it’s 62%, and for Prince George’s County, it’s 64%.
To generate the report’s estimates, Rajan and his colleagues used data from the National Center for Health Statistics and the Chicago Health Aging Project. The latter is a study of more than 10,000 people in three neighborhoods on the South Side of Chicago that lasted from 1993 to 2012. The longitudinal study looked at common chronic health problems in older people, especially risk factors for developing Alzheimer’s disease.
What makes the Chicago Health Aging Project stand out is that more than 60% of its participants were Black, said Rajan, a professor in the internal medicine department for RUSH Medical College in Chicago who presented the recently published analysis Monday at the Alzheimer’s Association’s international conference in Amsterdam.
There are some Alzheimer’s cohort studies that include Black participants, but not to the extent there should be, he said. Even though national data indicates that Black people are more likely to have Alzheimer’s disease than white people, they’re about 35% less likely to be diagnosed with the disease and related dementias, according to research from the National Institute on Aging.
Rajan and his colleagues hope their research will bring attention to the importance of minority health as the population ages and the minority population is expected to grow in the coming decades. They also hope federal and state public health officials will use the data to determine where in the country more support is needed for people with Alzheimer’s and their loved ones.
The Greater Maryland chapter of the Alzheimer’s Association has long provided support to people living with the disease in Baltimore and their caregivers, said Ilene Rosenthal, the chapter’s program director. Now, the group is working with the city health department to raise awareness for the resources available and improve early detection rates.
Staff members are speaking at senior centers, churches and other locations across the city, and soon hope to work with health care providers to make sure they know what resources are available, too.
“There’s a wealth of information out there,” Rosenthal said. “The absolutely saddest thing that I ever hear is when someone says, ‘Oh, I could have used you when I was a caregiver.’ So, I try really hard every day to make [Alzheimer’s] a household word and help people know that there are resources and how to navigate that landscape.”
Alzheimer’s disease affects far more than the person living with the condition, said Dr. Hamila Amjad, an assistant professor of medicine in Johns Hopkins Medicine’s Division of Geriatric Medicine and Gerontology.
Caregivers and the patient’s family also experience social, emotional, financial and health challenges. And the effects of the disease can trickle down through generations, as family members have to cut back on work or school to care for their loved one.
Baltimore’s robust health care system means city residents live close to geriatric specialists who are in short supply elsewhere in the country, Amjad said. But whether the people who need those services are getting them remains a “big question mark,” she said. Beyond that, she added, the city needs to ensure that people with dementia receiving care at home receive the proper support.
“Are they able to afford and access a day center, a home care aide coming to the home?” she said. “Those are areas, I think, that were already stressed and challenged before COVID, but certainly with the pandemic, we saw the workforce decline. So, can we meet the need that people have?”
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