Experts argue more must be done to protect society’s vulnerable populations after a study revealed that individuals with dementia – in particular Black Americans – are at an increased risk of getting COVID-19.
Researchers from Case Western University studied electronic health record data from 61.9 million American adults and found the risk for contracting COVID-19 is twice as high for people with dementia than for those without it, according to the report published Tuesday in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association.
The findings also suggested patients were more likely to be hospitalized or die of COVID-19 than people without the cognitive disease.
The overall hospitalization risk during the study was about 25%, but it more than doubled for COVID-19 patients who had dementia – about 59%. The overall mortality risk was about 5%, but among those who also had dementia, about 20% died.
“Patients with dementia are more vulnerable both to acquire COVID infection and also do much worse with it when they do have it,” said Pamela Davis, professor of general medical sciences at Case Western University, who contributed to the study.
The study also highlighted disparities within this vulnerable population, even after controlling for other risk factors. Among those with dementia, Black patients had nearly three times the risk of being infected with COVID-19 as white patients did.
Seventy-three percent of Black patients with dementia were hospitalized during the study compared with about 53% of white patients. During the study, 23% of Black patients died compared with 19% of white patients.
More research is needed to fully understand why these disparities exist, said Brittany Baker, undergraduate program coordinator and clinical assistant professor at North Carolina Central University. But she speculates that Black dementia patients may be more at risk of contracting COVID-19 from their adult caregivers.
Black caregivers report providing more hours of care each week, 31.2 hours on average, compared with white caregivers, who provided on average 21.2 hours, according to a 2020 research report by the American Association of Retired Persons.
Black Americans also are less likely to get vaccinated than white Americans. Of the Black adults who say they won’t take the vaccine, half are worried they may get COVID-19 from it, according to a report by the Kaiser COVID-19 Vaccine Monitor.
“If (patients) are not in an extended facility, they’re at home. Their families are going to be of the same ethnicity and their family members are on the front lines,” Baker said. “We need to start from the front lines to make things equitable.”
Baker said more education and transparency is needed to overcome rational distrust in the medical system after centuries of structural racism, especially after a CDC study last week found that more than half of nursing home staff declined to get vaccinated against COVID-19 when they were offered a shot.
“It’s challenging because people with dementia need human contact and need the human interaction,” Davis said. “Yet it’s precisely the human interaction that could bring the COVID to them.”
The study controlled for other known risk factors of COVID-19 such as age, gender, underlying medical conditions and congregate living situations, said lead author Rong Xu, professor of biomedical informatics at Case Western. When researchers compared old dementia patients and younger dementia patients, she said, they found no statistical difference.
Health experts speculate symptoms of dementia – not the disease itself – may increase patients’ risk of getting COVID-19.
“It’s not likely that dementia itself makes people at risk,” said Heather Snyder, Alzheimer’s Association vice president of medical and scientific relations. “(It’s) things like forgetting to wear a mask, not remembering to keep physical distances or hand washing.”
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