Incidence of Alzheimer disease in a biracial urban community: relation to apolipoprotein E allele status
Evans DA, Bennett DA, Wilson RS, Bienias JL, Morris MC, Scherr PA, Hebert LE, Aggarwal N et al.. Archives of neurology, 2003-02-01
Topic: Amyloid, tau and blood-test diagnosis
Context Few studies compare Alzheimer disease (AD) incidence among black and white subjects. Objective To estimate incidence and the effect of the apolipoprotein E (APOE) epsilon4 allele in these races. Design Population-based study of disease incidence using a random, stratified sample. Setting A geographically defined community of 3 adjacent neighborhoods in Chicago, Ill. Participants A total of 6158 persons (78.7% overall; 80.5% of the black subjects and 74.6% of the white subjects) participated; 4.1 years later, persons initially free of AD were sampled for clinical evaluation for disease incidence (overall 842 persons [74.8%] participated; 67.6% of the black subjects and 81.9% of the white subjects). Interventions None. Main outcome measure Incident, clinically diagnosed AD. Results The effect of the APOE epsilon4 allele on the risk of AD differed strongly for black and white subjects. Among white subjects, the presence of the APOE epsilon4 allele was associated with a 2.73-fold (95% confidence interval [CI], 1.40-5.32) increase in risk while among black subjects there was no increase in risk (odds ratio, 1.02; 95% confidence interval, 0.39-2.68). Black race was associated with a nonsignificantly increased risk of AD with an odds ratio of 1.84 (95% CI, 0.73-4.66) if APOE and its interaction with race are considered, and an odds ratio of 1.28 (95% CI, 0.54-2.98) if they are not. The incidence of AD was 1.45% (95% CI, 0.89%-2.01%) per year among persons 65 to 74 years old, 4.73% (95% CI, 3.83%-5.64%) among those 75 to 84 years old, and 9.11% (95% CI, 7.36%-10.9%) among those 85 years and older. Conclusion Apolipoprotein E epsilon4 led to increased risk of AD among white subjects but not black subjects.
Key findings
- Participants A total of 6158 persons (78.7% overall; 80.5% of the black subjects and 74.6% of the white subjects) participated; 4.1 years later, persons initially free of AD were sampled for clinical evaluation for disease incidence (overall 842 persons [74.8%] participated; 67.6% of the black subjects and 81.9% of the white subjects).
- Results The effect of the APOE epsilon4 allele on the risk of AD differed strongly for black and white subjects.
- Among white subjects, the presence of the APOE epsilon4 allele was associated with a 2.73-fold (95% confidence interval [CI], 1.40-5.32) increase in risk while among black subjects there was no increase in risk (odds ratio, 1.02; 95% confidence interval, 0.39-2.68).
- Black race was associated with a nonsignificantly increased risk of AD with an odds ratio of 1.84 (95% CI, 0.73-4.66) if APOE and its interaction with race are considered, and an odds ratio of 1.28 (95% CI, 0.54-2.98) if they are not.
- Conclusion Apolipoprotein E epsilon4 led to increased risk of AD among white subjects but not black subjects.
Why it matters
In this population-based study, the APOE ε4 allele was associated with a 2.73-fold increase in Alzheimer disease risk among white participants but no increase in risk among black participants. This describes a difference in the effect of a genetic risk factor between races and does not test any treatment, cure, or prevention.
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Study details
- Participants6,158
- Effect size78.7%; 80.5%; 74.6%
- Evidence strengthLow
How this study scored 57/100
Published in a peer-reviewed journal. Scored zero for study design and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Archives of neurology) |
| Journal's citation record | 3 / 4 | Archives of Neurology: journal h-index 353 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2003 — older than 20 years, still counted |
| Sample size | 3 / 4 | 6,158 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 6 / 7 | Cited 371 times (OpenAlex, 2026-10-10) |
| Citations per year | 3 / 5 | 14.8 citations a year over 25 year(s) since 2003 |
| Impact for its field and year | 4 / 6 | Cited 13.3× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 4 / 6 | Cited by 53 other studies in this library |
| Still being cited | 2 / 4 | Cited 33 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 4 / 4 | Last-listed author Julie A. Schneider: h-index 151 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | Centers for Disease Control and Prevention: institution h-index 1,304 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 2 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 12580702) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 57 / 100 | — |
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
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APA 7th
Evans, D. A., Bennett, D. A., Wilson, R. S., Bienias, J. L., Morris, M. C., Scherr, P. A., et al. (2003). Incidence of Alzheimer disease in a biracial urban community: relation to apolipoprotein E allele status. Archives of neurology. https://doi.org/10.1001/archneur.60.2.185
Vancouver
Evans DA, Bennett DA, Wilson RS, Bienias JL, Morris MC, Scherr PA, et al. Incidence of Alzheimer disease in a biracial urban community: relation to apolipoprotein E allele status. Archives of neurology. 2003. doi:10.1001/archneur.60.2.185. PMID: 12580702.
BibTeX
@article{evans2003-12580702,
author = {Evans, D. A. and Bennett, D. A. and Wilson, R. S. and Bienias, J. L. and Morris, M. C. and Scherr, P. A. and Hebert, L. E. and Aggarwal, N. and others},
title = {{Incidence of Alzheimer disease in a biracial urban community: relation to apolipoprotein E allele status}},
journal = {Archives of neurology},
year = {2003},
doi = {10.1001/archneur.60.2.185},
pmid = {12580702},
url = {https://doi.org/10.1001/archneur.60.2.185}
}
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