<p class="first" id="d2770600e34">This article describes the public health impact
of Alzheimer's disease (AD), including
incidence and prevalence, mortality and morbidity, use and costs of care, and the
overall impact on caregivers and society. The Special Report discusses the challenges
of providing equitable health care for people with dementia in the United States.
An estimated 6.2 million Americans age 65 and older are living with Alzheimer's dementia
today. This number could grow to 13.8 million by 2060 barring the development of medical
breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499
deaths from AD in 2019, the latest year for which data are available, making Alzheimer's
the sixth-leading cause of death in the United States and the fifth-leading cause
of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke,
heart disease and HIV decreased, whereas reported deaths from AD increased more than
145%. This trajectory of deaths from AD was likely exacerbated in 2020 by the COVID-19
pandemic. More than 11 million family members and other unpaid caregivers provided
an estimated 15.3 billion hours of care to people with Alzheimer's or other dementias
in 2020. These figures reflect a decline in the number of caregivers compared with
a decade earlier, as well as an increase in the amount of care provided by each remaining
caregiver. Unpaid dementia caregiving was valued at $256.7 billion in 2020. Its costs,
however, extend to family caregivers' increased risk for emotional distress and negative
mental and physical health outcomes - costs that have been aggravated by COVID-19.
Average per-person Medicare payments for services to beneficiaries age 65 and older
with AD or other dementias are more than three times as great as payments for beneficiaries
without these conditions, and Medicaid payments are more than 23 times as great. Total
payments in 2021 for health care, long-term care and hospice services for people age
65 and older with dementia are estimated to be $355 billion. Despite years of efforts
to make health care more equitable in the United States, racial and ethnic disparities
remain - both in terms of health disparities, which involve differences in the burden
of illness, and health care disparities, which involve differences in the ability
to use health care services. Blacks, Hispanics, Asian Americans and Native Americans
continue to have a higher burden of illness and lower access to health care compared
with Whites. Such disparities, which have become more apparent during COVID-19, extend
to dementia care. Surveys commissioned by the Alzheimer's Association recently shed
new light on the role of discrimination in dementia care, the varying levels of trust
between racial and ethnic groups in medical research, and the differences between
groups in their levels of concern about and awareness of Alzheimer's disease. These
findings emphasize the need to increase racial and ethnic diversity in both the dementia
care workforce and in Alzheimer's clinical trials.
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