Students in the Master of Public Policy program at Duke’s Sanford School of Public Policy spent part of their spring semester examining a policy issue for the N.C. Center for Public Policy Research.
The students investigated Alzheimer’s disease in North Carolina, looking at the rates of the disease, caregiving options for patients, and also looked to other states to learn about different options for comprehensive plans.
The students’ report, which includes recommendations for action in our state, is presented in this series of blog posts. Today’s post takes a specific look at Alzheimer’s mortality rates in some North Carolina counties, and analyzes possible reasons for the range in impact. Read previous posts here:
Part One in the series provides an introduction to Alzheimer’s disease and an overview of prevalence rates
Part Two discusses caregiving options
Part Three takes a look at programs and services supporting Alzheimer’s patients in N.C.
Part Four outlines how coverage for Alzheimer’s care continues to change, and touches on mental health reform in the state
Note: The pictures used in this series are from the Alzheimer’s North Carolina organization, a nonprofit dedicated to education, support, and advocacy for Alzheimer’s patients and their families. Visit their website here: http://www.alznc.org/.
Pictures also featured from The A.R.C. Community, long-term care facilities in North Carolina for residents with Alzheimer’s. www.thearccommunity.com
Alzheimer’s in North Carolina at the County Level
Between 2001 and 2013, North Carolina had an average Alzheimer’s mortality rate of 28.4 deaths per 100,000 people. During the same period, 46 of 100 counties recorded particularly high Alzheimer’s mortality rates, in excess of 40 deaths per 100,000. Many of these counties only recorded a single year with an especially high rate. However, a handful demonstrated consistently high mortality rates throughout this period. In particular, neighboring counties Union and Mecklenburg reported consistently high rates of Alzheimer’s mortality over the 13-year period. The average Alzheimer’s mortality rate in Union County over this period was 54.7 deaths per 100,000 and Mecklenburg County’s was 43.97. In four of these years, Union County had the highest rate in North Carolina.
Highest County Alzheimer’s Mortality Rates, 2001-2013
Age-adjusted, per 100,000 population (click to enlarge)
Union, Mecklenburg, and Iredell are contiguous counties in the Southern Piedmont. Granville is the only county in the state with a chronically high Alzheimer’s mortality rate not adjacent to other counties with similarly high rates.
North Carolina Alzheimer’s disease Mortality Rates by County, 2001-2013
The reason for chronically high Alzheimer’s mortality rates in certain regions within North Carolina is unclear. Mortality rate data for Alzheimer’s are typically gathered from death certificates that identify Alzheimer’s as the primary cause of death. For a consistent number of people to die annually of the same disease in a particular location suggests that some regional characteristic may play a role in prevalence. Because the data have been age-adjusted, particularly high mortality rates do not reflect the presence of a disproportionately large elderly population.
Union County has the highest Alzheimer’s mortality rate in the state.
There are two mechanisms that could contribute to a disproportionate impact for some counties:
1) A county may feature particular amenities that attract people with Alzheimer’s.
2) A county may have a population that is especially prone to developing Alzheimer’s.
In the former case, county variations in Alzheimer’s care capacity may be at play. In the latter, certain environmental or regional characteristics may be to blame. Alzheimer’s care facilities in North Carolina are not necessarily located in areas with the greatest need. Care capacity for Alzheimer’s is concentrated in urban counties in the middle of the state. Mecklenburg is the only county most afflicted by Alzheimer’s with a large number of facility beds dedicated to Alzheimer’s patients. Most counties with high Alzheimer’s mortality rates are in the southern Piedmont or the Western region. Between 2001 and 2013, New Hanover County in Southeastern North Carolina consistently had the lowest Alzheimer’s mortality rate in the state, with an average of 11.5 deaths per 100,000. Despite its low mortality rate, New Hanover exceeds 95% of North Carolina counties in Alzheimer’s care capacity.
Alzheimer’s Care Facilities by County
In 2008, Union County commissioned a study by geologists at Duke University on arsenic levels in the groundwater. The study ended due to a lack of funding. Yet the Union County Health Department was “interested in pursuing any potential linkage between the arsenic in well water with high Alzheimer’s rates, or cancer incidence (Morgan, 2012, 13).” Many residents of Union County rely heavily on well water, mostly from private wells not subject to filtration requirements. “The county has not extended water lines across the entire county, leaving some residents reliant on well water which is a concern. Filtration systems are available, but are financially out of reach for many families (Morgan, 2012, 13).” The map below shows especially high concentrations of arsenic in North Carolina’s Slate Belt, which lies directly beneath many counties in the southern Piedmont, including Union and Mecklenburg.
Distribution of Arsenic in Groundwater in North Carolina
Besides care facilities and groundwater contamination, other possibilities might explain the county-level variation in Alzheimer’s rates. Other characteristics that might play a role include idiosyncrasies in how cause of death is reported, exposure to other toxins, or other unknown variations in regional or environmental factors. Because the causes of Alzheimer’s disease remain largely unknown, no method exists to determine with certainty what factors cause such variation within North Carolina. 1
Note: Here is information about this student project, provided by the Duke Sanford School of Public Policy.
This student presentation was prepared during the spring of 2015 in partial completion of the requirements for PUBPOL 804, a course in the Master of Public Policy Program at the Sanford School of Public Policy at Duke University. The research, analysis, policy alternatives, and recommendations contained in this report are the work of the student team that authored the report, and do not represent the official or unofficial views of the Sanford School of Public Policy or of Duke University. Without the specific permission of its authors, this report may not be used or cited for any purpose other than to inform the client organization about the subject matter. The authors relied in many instances on data provided to them by the client and related organizations and make no independent representations as to the accuracy of the data.
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