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Alzheimer's disease and related dementias (ADRD) are an expanding worldwide crisis. In the absence of scientific breakthroughs, the global prevalence of ADRD will continue to increase as more people are living longer. Racial or ethnic minority groups have an increased risk and incidence of ADRD and have often been neglected by the scientific research community. There is mounting evidence that vascular insults in the brain can initiate a series of biological events leading to neurodegeneration, cognitive impairment, and ADRD. We are a group of researchers interested in developing and expanding ADRD research, with an emphasis on vascular contributions to dementia, to serve our local diverse community. Toward this goal, the primary objective of this review was to investigate and better understand health disparities in Alabama and the contributions of the social determinants of health to those disparities, particularly in the context of vascular dysfunction in ADRD. Here, we explain the neurovascular dysfunction associated with Alzheimer's disease (AD) as well as the intrinsic and extrinsic risk factors contributing to dysfunction of the neurovascular unit (NVU). Next, we ascertain ethnoregional health disparities of individuals living in Alabama, as well as relevant vascular risk factors linked to AD. We also discuss current pharmaceutical and non-pharmaceutical treatment options for neurovascular dysfunction, mild cognitive impairment (MCI) and AD, including relevant studies and ongoing clinical trials. Overall, individuals in Alabama are adversely affected by social and structural determinants of health leading to health disparities, driven by rurality, ethnic minority status, and lower socioeconomic status (SES). In general, these communities have limited access to healthcare and healthy food and other amenities resulting in decreased opportunities for early diagnosis of and pharmaceutical treatments for ADRD. Although this review is focused on the current state of health disparities of ADRD patients in Alabama, future studies must include diversity of race, ethnicity, and region to best be able to treat all individuals affected by ADRD. [ABSTRACT FROM AUTHOR]

Background: The National Institute for Minority Health and Health Disparities funded Centers of Excellence to address health disparities through research, education and professional training, and community engagement. This article summarizes a decade of multigenerational educational programing embedded in the Community Engagement Core (CEC) of the National Institute for Minority Health and Health Disparities-funded Center for Healthy Communities-Center of Excellence at the University of South Alabama., Objectives: Our objective is to demonstrate how community-based participatory research (CBPR) initiated the multigenerational approach, uniting the community health education and the educational pipeline programs, and transformed a traditional professional symposium into a mechanism to increase community participation and action., Methods: Community engagement and education adhered to CBPR principles and methods. A 3-year planning process before full funding of the Center of Excellence allowed the CHC to develop community partnerships and implement pilot projects that would assure community access and participation in COE programs. Program innovation was rooted in community suggestions and community priorities. The annual Regional Health Disparities Symposium (RHDS) was literally transformed through community engagement., Conclusions: Education programs for adults and youth achieved their goals independently, the STARS AND STRIPES (Student Training for Academic Reinforcement in the Sciences and Special Training to Raise Interest and Prepare for Entry into the Sciences) pipeline program has a success rate of 88% for participants' admission to colleges and universities. CHA-led events have documented an outreach to more than 6,500 community members and the COE has funded eight CHA-led projects directly addressing community action plans developed through CBPR methods during the history of the RHDS. But the real story has emerged from transformative multigenerational interaction via CBPR.

This study sought to elicit challenges and solutions in the provision of health care to those with chronic diseases after Hurricane Katrina in coastal Alabama and Mississippi. In-depth interviews with 30 health and social service providers (key informants) and 4 focus groups with patients with chronic diseases were conducted. Subsequently an advisory panel of key informants was convened. Findings were summarized and key informants submitted additional feedback. The chronic diseases identified as medical management priorities by key informants were mental health, diabetes mellitus, hypertension, respiratory illness, end-stage renal disease, cardiovascular disease, and cancer. The most frequently mentioned barrier to providing care was maintaining continuity of medications. Contributing factors were inadequate information (inaccessible medical records, poor patient knowledge) and financial constraints. Implemented or suggested solutions included relaxation of insurance limitations preventing advance prescription refills; better predisaster patient education to improve medical knowledge; promotion of personal health records; support for information technology systems at community health centers, in particular electronic medical records; improved allocation of donated medications/medical supplies (centralized coordination, decentralized distribution); and networking between local responders and external aid.

Objective: Having local health data is critical to combat health disparities, and zip code-level data are an underutilized source of such information. We sought to use zip code-level mortality data to determine where health disparities existed in our local area., Methods: The most heavily populated zip codes were aggregated into 2 groups: (1) study area population (SAP) where >or=20% of individuals lived in poverty in 1999; (2) comparison area population, <20% in poverty. Disease-specific mortality rates (per 100,000 population) were calculated and compared. The relative risk (RR) of death from specific causes was the ratio of the mortality rate experienced by the SAP compared with that experienced by the comparison area population., Results: The SAP had higher percentages of African Americans and women and much lower levels of income, employment, and education. Some zip codes in SAP had over 40% living below the poverty level. The RR of death from all but 4 of the 22 causes examined was >or=40% higher in the SAP. Major disparities (RR >2.5) were seen for human immunodeficiency virus, homicide, hypertensive heart and renal disease, and kidney disease. Actual death rates were highest for major cardiovascular disease and cancer, and the level of disparities here (RR approximately 1.4) make them important areas for concentration., Conclusion: Using zip code-level data provides an accurate foundation from which to design local interventions to address health disparities.