Introduction: Alzheimer’s disease and related dementias (ADRD) significantly impact Black individuals. However, the practice of grouping all Black individuals together, without considering the ethnoracial differences within subgroups, may overlook crucial factors influencing ADRD risk and progression. Thus, this study examines ADRD prevalence stratified by nativity among US-born and non-US-born Black individuals to identify differences in risk factors and inform targeted interventions.

Methods: We conducted a retrospective cohort study utilizing data from the All of Us (AoU) Research program comprising 77,069 Black individuals with recorded birthplace information. We created and analyzed two cohorts: US-born and non-US-born Black individuals with ADRD diagnoses as determined using ICD-9 and ICD-10 codes. Propensity score matching was employed to ensure balanced cohorts in terms of key demographic and socioeconomic parameters, including age, gender, and nativity for comparison. Statistical analyses were conducted using R and Python, with significance set at α = 0.05.

Results: We initially included 72,311 US-born and 4,758 non-US-born Black individuals. Following 1:1 propensity score matching, 4,758 participants were matched in each group. The prevalence of ADRD was 3.76% among US-born Blacks and 4.12% among non-US-born Blacks, consistent with pre-matching levels. ADRD prevalence increased with older age and was higher among retirees and those unable to work compared to working adults.

Conclusion: Non-US-born Black individuals face higher ADRD risk than US-born Blacks, due to socioeconomic factors such as income and employment, and demographic factors like age. While findings support targeted interventions, further research is needed to refine these approaches and address health inequities.