Skip to main content

Advertisement

SpringerLink
Log in

Suspected Undiagnosed ADRD Among Middle Eastern and North African Americans

  • Original Paper
  • Published:
Journal of Immigrant and Minority Health Aims and scope Submit manuscript

Abstract

ADRD underdiagnosis among minority populations is well-established and known to be more prevalent among women. Yet, it remains unclear if these patterns exist among adults of Middle Eastern and North African (MENA) descent. We estimated ADRD underdiagnosis among adults of MENA descent and other US- and foreign-born non-Hispanic Whites and compared sex-stratified results. We linked 2000–2017 National Health Interview Survey and 2001–2018 Medical Expenditure Panel Survey data (ages > = 65 years, n = 23,981). Undiagnosed ADRD was suspected if participants reported cognitive limitations without corresponding ADRD diagnosis. Undiagnosed ADRD was highest among adults of MENA descent (15.8%) compared to non-Hispanic Whites (US-born = 8.1%; foreign-born = 11.8%). Women of MENA descent had 2.52 times greater odds (95% CI = 1.31–4.84) of undiagnosed ADRD compared to US-born White women after adjusting for risk factors. This study contributes the first national estimates of undiagnosed ADRD among adults of MENA descent. Continued research is needed to facilitate policy changes that more comprehensively address health disparities and related resource allocation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Alzheimer’s Association. 2022 Alzheimer’s disease facts and figures. Alzheimers Dement. 2022;18:700–89.

  2. Amjad H, Roth DL, Sheehan OC, Lyketsos CG, Wolff JL, Samus QM. Underdiagnosis of dementia: an observational study of patterns in diagnosis and awareness in US older adults. J Gen Intern Med. 2018;33:1131–8.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Gianattasio KZ, Prather C, Glymour MM, Ciarleglio A, Power MC. Racial disparities and temporal trends in dementia misdiagnosis risk in the United States. Alzheimers Dement (N Y). 2019;5:891–8.

    Article  PubMed  Google Scholar 

  4. Fitten LJ, Ortiz F, Pontón M. Frequency of Alzheimer’s disease and other dementias in a community outreach sample of Hispanics. J Am Geriatr Soc. 2001;49:1301–8.

    Article  CAS  PubMed  Google Scholar 

  5. Minority Health and Health Disparities. : Definitions and Parameters [Internet]. NIMHD. [cited 2022 Mar 3]. Available from: https://www.nimhd.nih.gov/about/strategic-plan/nih-strategic-plan-definitions-and-parameters.html.

  6. Awad GH, Abuelezam NN, Ajrouch KJ, Stiffler MJ. Lack of arab or middle eastern and north African Health Data undermines Assessment of Health Disparities. Am J Public Health. 2022;112:209–12.

    Article  PubMed  Google Scholar 

  7. Arab American Institute Foundation. Demographics [Internet]. 2018. Available from: https://www.aaiusa.org/demographics.

  8. Ajrouch KJ, Zahodne LB, Antonucci TC. Arab american cognitive aging: Opportunities for advancing Research on Alzheimer’s Disease Disparities. Innov Aging. 2017;1(3):igx034.

    Article  PubMed  Google Scholar 

  9. Rooks N, Thorpe RJ Jr. Roland. Intersections Among Gender, Race, and Ethnicity: Implications for Health. Handbook of Minority Aging [Internet]. New York: Springer Publishing Company; p. 455–70. Available from: https://connect.springerpub.com/content/book/978-0-82610964-4/part/part04/chapter/ch28.

  10. Kindratt TB, Dallo FJ, Zahodne LB, Ajrouch KJ. Cognitive Limitations among Middle Eastern and North African Immigrants. J Aging Health. 2022;34(9–10):1244–53.

    Article  PubMed  Google Scholar 

  11. Dallo FJ, Kindratt TB, Zahodne L. Prevalence of self-reported cognitive impairment among arab american immigrants in the United States. Innov Aging. 2020;5(1):igaa058.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Kindratt TB, Dallo FJ, Zahodne LB. Cognitive disability among Arab Americans by Nativity status and arrival year: lack of evidence for the healthy migrant effect. J Racial Ethn Health Disparities. 2022;9(5):2056–62.

    Article  PubMed  Google Scholar 

  13. Read JG, Reynolds MM. Gender differences in immigrant health: the case of mexican and middle eastern immigrants. J Health Soc Behav. 2012;53:99–123.

    Article  PubMed  Google Scholar 

  14. NHIS - National Health Interview Survey [Internet]. 2022 [cited 2022 Mar 3]. Available from: https://www.cdc.gov/nchs/nhis/index.htm.

  15. Agency for Healthcare Research and Quality (AHRQ). Medical Expenditure Panel Survey Home [Internet]. [cited 2020 Sep 2]. Available from: https://meps.ahrq.gov/mepsweb/.

  16. Novak P, Chu J, Ali MM, Chen J. Racial and ethnic disparities in Serious Psychological Distress among those with Alzheimer’s Disease and related dementias. Am J Geriatr Psychiatry. 2020;28:478–90.

    Article  PubMed  Google Scholar 

  17. Medical Expenditure Panel Survey Public. Use File Details [Internet]. [cited 2020 Dec 11]. Available from: https://meps.ahrq.gov/data_stats/download_data_files_detail.jsp?cboPufNumber=NHIS%20Link.

  18. Jain S, Rosenbaum PR, Reiter JG, Hoffman G, Small DS, Ha J, et al. Using Medicare claims in identifying Alzheimer’s disease and related dementias. Alzheimers Dement. 2020. alz.12199.

  19. Matthews K, Phelan J, Jones N, Konya S, Marks R, Pratt B, et al. 2015 National Content Test Race and Ethnicity Analysis Report: a New Design for the 21st Century. US Census Bureau; 2017.

  20. Wang H. Biden Wants Census To See “Invisible” Groups: LGBTQ, Middle Eastern, North African [Internet]. 2020. Available from: https://www.npr.org/2020/11/14/932594879/biden-wants-census-to-see-invisible-groups-lgbtq-middle-eastern-north-african.

  21. Livingston G, Sommerlad A, Orgeta V, Costafreda SG, Huntley J, Ames D, et al. Dementia prevention, intervention, and care. Lancet. 2017;390:2673–734.

    Article  PubMed  Google Scholar 

  22. Read JG, Lynch SM, West JS. Disaggregating heterogeneity among non-hispanic whites: evidence and implications for U.S. Racial/Ethnic Health Disparities. Popul Res Policy Rev. 2021;40:9–31.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Fernandez DM, Larson JL, Zikmund-Fisher BJ. Associations between health literacy and preventive health behaviors among older adults: findings from the health and retirement study. BMC Public Health. 2016;16:596.

    Article  PubMed  PubMed Central  Google Scholar 

  24. US Preventive Services Task Force, Owens DK, Davidson KW, Krist AH, Barry MJ, Cabana M, et al. Screening for cognitive impairment in older adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2020;323:757–63.

    Article  Google Scholar 

  25. Read JG, Amick B, Donato KM. Arab immigrants: a new case for ethnicity and health? Soc Sci Med. 2005;61:77–82.

    Article  PubMed  Google Scholar 

  26. Dallo FJ, Kindratt TB. Disparities in Chronic Disease Prevalence among non-hispanic whites: heterogeneity among Foreign-Born Arab and European Americans. J Racial Ethn Health Disparities. 2016;3:590–8.

    Article  PubMed  Google Scholar 

  27. Dallo FJ, Al Snih S, Ajrouch KJ. Prevalence of disability among US- and foreign-born arab Americans: results from the 2000 US Census. Gerontology. 2009;55:153–61.

    Article  PubMed  Google Scholar 

  28. Dallo FJ, Booza J, Nguyen ND. Functional limitations and nativity status among older arab, asian, black, hispanic, and white Americans. J Immigr Minor Health. 2015;17:535–42.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Dallo FJ, Kindratt TB, Snell T. Serious psychological distress among non-hispanic whites in the United States: the importance of nativity status and region of birth. Soc Psychiatry Psychiatr Epidemiol. 2013;48:1923–30.

    Article  PubMed  Google Scholar 

  30. Kindratt TB, Dallo FJ, Roddy J. Cigarette smoking among US- and foreign-born european and arab american non-hispanic White Men and Women. J Racial Ethn Health Disparities. 2018;5:1284–92.

    Article  PubMed  Google Scholar 

  31. Read JG, Ajrouch KJ, West JS. Disparities in functional disability among arab Americans by nativity, immigrant arrival cohort, and country of birth. SSM Popul Health. 2019;7:100325.

    Article  PubMed  Google Scholar 

  32. Dallo FJ, Kindratt TB. Disparities in vaccinations and cancer screening among U.S.- and foreign-born arab and european american non-hispanic white women. Womens Health Issues. 2015;25:56–62.

    Article  PubMed  Google Scholar 

  33. Dallo FJ, Kindratt TB. Disparities in preventive health behaviors among non-hispanic white men: heterogeneity among foreign-born arab and european Americans. Am J Mens Health. 2015;9:124–31.

    Article  PubMed  Google Scholar 

  34. Wrobel NH, Farrag MF, Hymes RW. Acculturative stress and depression in an elderly arabic sample. J Cross Cult Gerontol. 2009;24:273–90.

    Article  PubMed  Google Scholar 

  35. Kindratt TB. Improving the collection of national health data: the case for the Middle Eastern and North African checkbox in the United States. Res square. 2023. https://doi.org/10.21203/rs.3.rs-2790994/v2.

    Article  Google Scholar 

  36. Livingston G, Huntley J, Sommerlad A, Ames D, Ballard C, Banerjee S, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet. 2020;396:413–46.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Byers AL, Arean PA, Yaffe K. Low use of mental health services among older Americans with mood and anxiety disorders. Psychiatr Serv. 2012;63:66–72.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Park M, Unützer J. Geriatric depression in primary care. Psychiatr Clin North Am. 2011;34:469–87. ix–x.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Noël PH, Williams JW, Unützer J, Worchel J, Lee S, Cornell J, et al. Depression and comorbid illness in elderly primary care patients: impact on multiple domains of health status and well-being. Ann Fam Med. 2004;2:555–62.

    Article  PubMed  PubMed Central  Google Scholar 

  40. DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med. 2000;160:2101–7.

    Article  CAS  PubMed  Google Scholar 

  41. Pampati S, Alattar Z, Cordoba E, Tariq M, Mendes de Leon C. Mental health outcomes among arab refugees, immigrants, and U.S. born Arab Americans in Southeast Michigan: a cross-sectional study. BMC Psychiatry. 2018;18:379.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Ajrouch KJ. Resources and well-being among arab-american elders. J Cross Cult Gerontol. 2007;22:167–82.

    Article  PubMed  Google Scholar 

  43. Suleiman A-R, Afify O, Whitfield KE. The effect of stress, Acculturation, and Heritage Identity on Depression in Arab Americans. J Community Hosp Intern Med Perspect. 2021;11:433–8.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Dallo FJ, Prabhakar D, Ruterbusch J, Schwartz K, Peterson EL, Liu B, et al. Screening and follow-up for depression among arab Americans. Depress Anxiety. 2018;35:1198–206.

    Article  PubMed  Google Scholar 

  45. Abuelezam NN, El-Sayed A, Galea S, Gordon NP. Understanding differences within ethnic group designation: comparing risk factors and health indicators between iranian and arab Americans in Northern California. BMC Public Health. 2021;21:1074.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Abuelezam NN, El-Sayed AM, Galea S. The Health of Arab Americans in the United States: an updated Comprehensive Literature Review. Front Public Health. 2018;6:262.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Abdulrahim S, Ajrouch KJ, Morrison M. Hiding health problems: culture and stigma. In: Nassar SC, Ajrouch KJ, Dallo FJ, Hakim-Larson J, editors. Biopsychosocial perspectives on Arab Americans: culture, development, and health, Second edition. Springer: 2023. In press.

  48. Ajrouch KJ, Janevic MR, Antonucci T. Adapting an Alzheimer’s disease care intervention for Arab American families. In: Nassar SC, Ajrouch KJ, Dallo FJ, Hakim-Larson J, editors. Biopsychosocial perspectives on Arab Americans: culture, development, and health, Second edition. Springer: 2023. In press.

Download references

Acknowledgements

This work was supported by the National Institutes of Health, National Institute on Aging [grant numbers R03AG070177, P30AG059300]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This research was conducted at a Federal Statistical Research Data Center, and the support of Agency for Healthcare Research and Quality (AHRQ) is acknowledged. Results and conclusions are those of the author and do not indicate concurrence by AHRQ or the Department of Health and Human Services.

Author information

Authors and Affiliations

  1. Public Health Program, Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, 500 West Nedderman Drive, Arlington, TX, 76019, USA

    Tiffany B. Kindratt

  2. Department of Sociology, Anthropology and Criminology, Eastern Michigan University, 712 Pray-Harrold, Ypsilanti, MI, 48197, USA

    Kristine J. Ajrouch

  3. Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI, 48104, USA

    Kristine J. Ajrouch & Laura B. Zahodne

  4. Department of Psychology, University of Michigan, 530 Church St., Ann Arbor, MI, 48109, USA

    Laura B. Zahodne

  5. School of Health Sciences, Oakland University, Rochester, MI, 48309-4452, USA

    Florence J. Dallo

Authors
  1. Tiffany B. Kindratt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kristine J. Ajrouch
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Laura B. Zahodne
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Florence J. Dallo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tiffany B. Kindratt.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kindratt, T.B., Ajrouch, K.J., Zahodne, L.B. et al. Suspected Undiagnosed ADRD Among Middle Eastern and North African Americans. J Immigrant Minority Health 25, 1098–1107 (2023). https://doi.org/10.1007/s10903-023-01509-x

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10903-023-01509-x

Keywords

Search

Navigation