Abstract
OBJECTIVES: To test the hypothesis that the geographic pattern of mortality with dementia coded on the death certificate varies according to race and that racial differences vary according to geography in the United States. DESIGN: Analysis of the U.S. multiple-cause-of-death files for 1999 to 2004. SETTING: United States. PARTICIPANTS: Decedents with dementia coded as underlying or contributing cause of death on the death certificate. MEASUREMENTS: Age-adjusted death rates for U.S. Census geographic divisions for blacks and whites aged 65 and older. RESULTS: From 1999 to 2004, the U.S. age-adjusted annual death rate per 100,000 for dementia was 628 in blacks and 647 in whites. The difference between rates in blacks and whites ranged from -130 deaths per 100,000 (-36%) in the Middle Atlantic region to +55 (+8%) in the South Atlantic division. Blacks had higher rates in three divisions and whites in five. In the Middle Atlantic and in the United States as a whole, blacks were relatively more likely to receive a diagnosis of unspecified dementia or senility (66%) than Alzheimer's disease (30%) than whites (58% and 41%, respectively). CONCLUSION: Although overall rates were similar, geographic variation in racial differences in rates of death with dementia occurred between U.S. regions. Further research is needed to assess geographic and racial variation in artifacts of certification versus biological variation as possible causes of variation to enhance utility of mortality data for disease monitoring and health-disparities research.