Social Inequality and Alzheimer’s Disease

Social Inequality and Alzheimer’s Disease

Social Inequality and Alzheimer’s Disease

Racial and ethnic disparities exist in the occurrence of Alzheimer’s disease in the U.S. There are variations in the way Alzheimer’s manifests within African American, Hispanic, and non-Hispanic white populations.[1] Existing research indicates that certain minority groups are at greater risk for the disease as a result of racial, educational, and socioeconomic inequalities. Understanding these disparities is the first step to take for medical communities, and for society as a whole, to reduce the prevalence of Alzheimer’s disease. In this article, we will discuss some of the socioeconomic factors responsible for these disparities. These factors will encompass a focus on the relationships between race, income, education, and access to healthcare, focusing particularly on the role of education and the benefits it can confer.

Racial Disparities in Alzheimer’s

According to the Alzheimer’s Association, black individuals are twice as likely to develop Alzheimer’s than white individuals, and Hispanic individuals are 1.5 times more likely to develop Alzheimer’s than white individuals.[2] Education, income, and living/occupational conditions can all contribute to cognitive health outcomes in old age. For instance, less than twelve years of education, making less than $18,000 a year, and living in rural areas are all correlated with increased cognitive impairment among black, Hispanic, and white populations. However, black and Hispanic populations are impacted more heavily than white populations (see Figure 1). These data indicate what may already be well known: Being white, having a higher education, more money, or living in more affluent locations may increase access to healthcare or influence a healthier lifestyle, which can lead to overall better health in old age.

Figure 1

Figure 1 – Source: Alzheimer’s Association, 2010, cited in “Racial and Ethnic Disparities in Alzheimer’s Disease: A Literature Review,” 2014.

One way to picture inequality in the U.S. is through certain systemic disparities, like among black, Hispanic, and white household incomes. According to the U.S. Census Bureau, between 2013 and 2014, the median white household had an annual income of $60,256. That is contrasted by a median income of $35,398 and $42,491 for black and Hispanic households, respectively.[3] If certain households had more money, then this could be a way to decrease the prevalence of Alzheimer’s. NPR recently reported on a natural experiment where more Social Security benefits were accidentally meted out to one cohort in the 1970s. This resulted from a glitch in Congress’s computer program which was responsible for allocating Social Security benefits. The benefits accidentally given out were higher compared to those in the next cohort, thereby creating two similar groups to study. What the “experiment” showed was that those who received more money “ended up with better cognitive function.”[4] Furthermore, these findings were clinically meaningful, meaning there was a notable change in the probability that someone would be labeled as cognitively impaired in old age. This could suggest to policy makers that certain financial decisions, like those within Social Security policies, can have significant public health consequences.[5] One can surmise, then, that a higher salary earlier in life may also contribute to positive health outcomes later in life.

Could Education be the Answer?

A solution to the disparities we see in Alzheimer’s could be to provide better access to schooling and healthcare for minority groups, which would have benefits beyond avoiding cognitive impairment in old age. Access to better education has been associated with better cognitive and physical health later on.[6] Yet such access is often influenced by one’s income level and where one lives. As a result of racial and income inequality, minority groups usually do not have access to the same schools to which more affluent communities have. For instance, rising college tuition costs means that many graduating high school seniors from low income families are unable to afford tuition and, thus, attend a university. Graduating from a university is correlated with increases in median annual earnings compared to graduating with only a high school diploma.[7]  If low income students are unable to attend a university, then they will not have access to the same opportunities that would benefit a college graduate, therefore hindering the chances of receiving a higher salary. Earning a higher salary could allow one to invest in one’s health and increases their access to healthcare services since one of the many barriers to healthcare is its unaffordability for low income families.[8] Some people have suggested that more education will not solve income inequality, at least not significantly. That is because the wealth increases that would be seen by individuals from low income environments would still very low compared to the super rich, i.e. the top one percent or even the top 0.01%.[9] Income inequality would therefore still be a problem, but an increase in wealth, albeit a small one, for certain people could have beneficial, meaningful, and significant impacts on their health throughout their lives. We therefore find that cognitive diseases like Alzheimer’s are influenced not just by our biological makeup or factors from our material environment, but by the social and economic conditions in which we live. Racial and ethnic disparities in Alzheimer’s disease can be lessened if we focus on changing these social and economic conditions for the better, giving those communities who are most vulnerable the chance to ensure a healthier life now and in old age.

[1] Lines, Lisa M. and Joshua M. Wiener, “Racial and Ethnic Disparities in Alzheimer’s Disease: A Literature Review,” U.S. Department of Health and Human Services (2014), 3.

[2] Ibid.

[3] The U.S. Census Bureau, “Income and Poverty in the United States: 2014,”  BOC P60-252, (Washington, D.C., 2015), 7, https://www.census.gov/content/dam/Census/library/publications/2015/demo/p60-252.pdf.

[4] Source:  http://www.npr.org/2016/11/23/503108939/senior-citizens-study-how-money-makes-for-better-brain-functioning

[5] Ibid.

[6] Source: https://www.nia.nih.gov/alzheimers/publication/2011-2012-alzheimers-disease-progress-report/health-disparities-and

[7] Source: http://www.usnews.com/news/articles/2014/02/11/study-income-gap-between-young-college-and-high-school-grads-widens

[8] Source: http://www.medscape.com/viewarticle/567154

[9] Source: http://www.nytimes.com/2015/04/01/upshot/why-more-education-wont-fix-economic-inequality.html

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