Investigation of hypertension and type 2 diabetes as risk factors for dementia in the All of Us cohort
Authors: Nagar Shashwat Deepali , Pemu Priscilla , Qian Jun , Boerwinkle Eric , Cicek Mine , Clark Cheryl R. , Cohn Elizabeth , Gebo Kelly , Loperena Roxana , Mayo Kelsey , Mockrin Stephen , Ohno-Machado Lucila , Ramirez Andrea H. , Schully Sheri , Able Ashley , Green Ashley , Zuchner Stephan ,   SEEC Consortium, Pemu Priscilla E. , Quarshie Alexander , Carroll Kelley , Sanders Lawrence L. , Mosby Howard , Olorundare Elizabeth I. , McCaslin Atuarra , Anderson Chadrick , Pearson Andrea , Igwe Kelechi C. , Silva Karunamuni , Daugett Gwen , McCray Jason , Prude Michael , Franklin Cheryl , Zuchner Stephan , Carrasquillo Olveen , Isasi Rosario , McCauley Jacob L. , Melo Jose G. , Riccio Ana K. , Whitehead Patrice , Guzman Patricia , Gladfelter Christina , Velez Rebecca , Saporta Mario , Apagüeño Brandon , Abreu Lisa , Shenkman Betsy , Hogan Bill , Handberg Eileen , Hensley Jamie , White Sonya , Roth-Manning Brittney , Mendoza Tona , Loiacono Alex , Weinbrenner Donny , Enani Mahmoud , Nouina Ali , Zwick Michael E. , Rosser Tracie C. , Quyyumi Arshed A. , Johnson Theodore M. , Martin Greg S. , Alonso Alvaro , Thompson Tina-Ann Kerr , Deshpande Nita , Johnston H. Richard , Ahmed Hina , Husbands Letheshia , Jordan I. King , Meller Robert 
Published: November 2022

The World Health Organization recently defined hypertension and type 2 diabetes (T2D) as modifiable comorbidities leading to dementia and Alzheimer’s disease. In the United States (US), hypertension and T2D are health disparities, with higher prevalence seen for Black and Hispanic minority groups compared to the majority White population. We hypothesized that elevated prevalence of hypertension and T2D risk factors in Black and Hispanic groups may be associated with dementia disparities. We interrogated this hypothesis using a cross-sectional analysis of participant data from the All of Us (AoU) Research Program, a large observational cohort study of US residents. The specific objectives of our study were: (1) to compare the prevalence of dementia, hypertension, and T2D in the AoU cohort to previously reported prevalence values for the US population, (2) to investigate the association of hypertension, T2D, and race/ethnicity with dementia, and (3) to investigate whether race/ethnicity modify the association of hypertension and T2D with dementia. AoU participants were recruited from 2018 to 2019 as part of the initial project cohort (R2019Q4R3). Participants aged 40–80 with electronic health records and demographic data (age, sex, race, and ethnicity) were included for analysis, yielding a final cohort of 125,637 individuals. AoU participants show similar prevalence of hypertension (32.1%) and T2D (13.9%) compared to the US population (32.0% and 10.5%, respectively); however, the prevalence of dementia for AoU participants (0.44%) is an order of magnitude lower than seen for the US population (5%). AoU participants with dementia show a higher prevalence of hypertension (81.6% vs. 31.9%) and T2D (45.9% vs. 11.4%) compared to non-dementia participants. Dominance analysis of a multivariable logistic regression model with dementia as the outcome shows that hypertension, age, and T2D have the strongest associations with dementia. Hispanic was the only race/ethnicity group that showed a significant association with dementia, and the association of sex with dementia was non-significant. The association of T2D with dementia is likely explained by concurrent hypertension, since > 90% of participants with T2D also had hypertension. Black race and Hispanic ethnicity interact with hypertension, but not T2D, to increase the odds of dementia. This study underscores the utility of the AoU participant cohort to study disease prevalence and risk factors. We do notice a lower participation of aged minorities and participants with dementia, revealing an opportunity for targeted engagement. Our results indicate that targeting hypertension should be a priority for risk factor modifications to reduce dementia incidence.