Trends in Alzheimer’s Disease Mortality

Alzheimer’s disease is one of the leading causes of death among adults age 65 and older. While it is widely reported that the Alzheimer’s mortality rates are increasing, less attention is paid to how and why the recorded death rates change over time. This article analyzes Alzheimer’s mortality trends using state-level mortality data obtained from CDC Wonder,[1] with a focus on California, Texas, and Oregon.

Alzheimer’s disease is the most common form of dementia, a brain disorder that slowly destroys a person’s memory and thinking skills.

The rise in Alzheimer’s is often explained by the growth in the elderly population over time.[2] Nearly a decade ago, all-cause mortality rates in adults 65+ were largely driven by conditions including cancer, blood, and vascular diseases. As treatments and prevention for these conditions improved, the deaths due to them declined by roughly 30% on average across the three states from 2001 through 2020 (Figure 1), allowing more people to live longer. As a result, individuals are surviving to ages at which they are at higher risk of developing Alzheimer’s disease. This explanation implies that once age is accounted for, Alzheimer’s mortality rates should remain relatively stable over time.

Figure 1: Deaths per 100,000 due to cancer, blood and vascular diseases in adults 65+.

Figure 2 shows Alzheimer’s disease deaths per 100,000 people over time for adults age 65 and older. When focusing specifically on Alzheimer’s disease, an overall upward trend can be observed across all three states. However, each state exhibits a distinct pattern (Figure 3). California’s mortality rate more than doubled from 2001 to 2020 – rising by 132% from 134 to 311 deaths per 100,000 people.

Texas followed a similar pattern, with the death rate due to Alzheimer’s in that state increasing by 88% over the same period. When we look more closely at Texas and California, the rates increased drastically until around 2008. Following this period, the rates stabilized or showed a slight decline until about 2013. A noticeable increase then occurred over the next two years, after which the trend remains relatively steady before experiencing another sharp rise approaching 2020.

Oregon displays substantially higher rates than the other states in the earlier years of the dataset, particularly until about 2008.  For instance, in 2000, Oregon recorded approximately 230 deaths per 100,000 adults age 65 and older due to Alzheimer’s, compared with 134 in California and 162 in Texas. After 2008, Oregon’s rates declined and became more comparable to those of the other two states. Following 2014, Oregon’s Alzheimer’s death rate remained relatively stable and was the lowest among the three states.

Figure 2 – Alzheimer’s deaths per 100,000 (in adults age 65 and older).

Figure 3 – Alzheimer’s death rate in California, Oregon, and Texas from 2001-2020.

Breaking down the data further by age group (Figure 4) reveals two findings that complicate the simple aging narrative. First, the scale difference is stark: in 2020, adults age 85 and over died of Alzheimer’s at roughly 50 times the rate of those age 65-74. The 75-84 group sits between these extremes but remains closer to the younger cohort, suggesting that Alzheimer’s mortality risk accelerates sharply after 85. However, a gradual increase in mortality rates was also noticed in younger age groups – especially in seniors between 75-84 in California and Texas, where the number of deaths per 100,000 spiked by 99% and 80% respectively from 2001 to 2020. The 65-74 age group also saw a noticeable rise in fatalities. The takeaway is clear: while the oldest segments of the population remain the most vulnerable, Alzheimer’s is increasingly encroaching on younger generations, proving that this crisis is no longer confined to the very old.

Figure 4 – Alzheimer’s death rate in California, Oregon, and Texas across different age groups.

Deeper analysis reveals that all three states, despite their differing trends, share a flattening of mortality rates from 2009-2014 (Figure 5). This near-perfect synchrony points to something systematic – a shift in how deaths were being counted.

Figure 5 – Alzheimer’s deaths per 100,000 (adults 65 and older) indicate a plateau from 2009-2014.

 Several studies[3] suggest that the number of Alzheimer’s deaths in 2010 were found to be underreported. Some people with the disease never receive a diagnosis. Many others have dementia-related conditions, such as aspiration pneumonia, listed as the primary cause of death, while the underlying cause, Alzheimer’s, is not reported. The consistency in recorded Alzheimer’s deaths from 2009 to 2014 may be explained by reporting patterns rather than real changes in risk, because dementia is often not fully recorded on death certificates.

In 2011, the National Institute on Aging-Alzheimer’s Association (NIA-AA) updated the Alzheimer’s disease diagnostic criteria to incorporate biological markers (biomarkers) alongside clinical symptoms, covering the full disease spectrum – preclinical, mild cognitive impairment (MCI), and dementia.[4] Today, these new criteria allow the practicing clinician to diagnose Alzheimer’s disease with more clarity, providing greater certainty of the diagnosis for patients and families.

That same year, the Affordable Care Act (ACA) introduced the annual wellness visit (AWV), allowing Medicare beneficiaries to receive yearly, zero-co-payment preventive care visits to establish personalized health plans and screen for cognitive decline. Studies[5] performed in Texas from 2014-2020 show that Medicare beneficiaries who had an AWV were 23-66% more likely to be diagnosed at the MCI stage and 8-30% more likely to be diagnosed at the moderate Alzheimer’s disease and related dementias (ADRD) stage relative to those who did not have an AWV. This improved diagnostic detection could explain the end of 2009-2014 plateau and may have contributed to the spike observed after 2014.

Access to nutritious food and adequate healthcare are important social determinants that may influence the risk of Alzheimer’s disease and other forms of dementia. Diet quality has been linked to long-term brain health, as poor access to healthy food can lead to nutritional deficiencies and a higher prevalence of chronic conditions such as obesity, diabetes, and cardiovascular disease. These conditions are known risk factors for cognitive decline and may accelerate the progression of dementia in all senior age groups – not just the oldest.

In addition, healthcare access plays a significant role in prevention and diagnosis. Communities with limited access to healthcare services may experience delays in diagnosing cognitive impairment and managing related health conditions such as hypertension or diabetes, which can contribute to worsening brain health over time. Conversely, better healthcare access allows for earlier screening, improved management of risk factors, and greater awareness of neurological conditions.

For example, Texas and California rely heavily on massive commercial hospital networks and standard Medicare Advantage plans to independently push the AWV, while Oregon prefers co-ordinated care organizations (CCOs), introduced in 2012, that excel at tracking low-income seniors and bridge rural care gaps.

The increase in Alzheimer’s mortality cannot be explained by population aging alone. While longer lifespans play a role, patterns in the data suggest that changes in diagnosis and reporting have also shaped the trends we see today. The plateau observed from 2009 through 2014 across multiple states points to reporting practices rather than true stabilization of disease risk. Understanding these distinctions matters. Mortality data influences how resources are allocated, how research priorities are set, and how the burden of Alzheimer’s disease is perceived at a national level.

References

[1] Centers for Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System, Mortality 1999-2020 on CDC WONDER Online Database, released in 2021. Data are from the Multiple Cause of Death Files, 1999-2020, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at About Underlying Cause of Death, 1999-2020 on November 28, 2025 5:53:35 AM

[2] Why the number of Americans with Alzheimer’s could more than double by 2050

[3] Number of Alzheimer’s deaths found to be underreported

[4] The new 2011 recommendations of the National Institute on Aging and the Alzheimer’s Association on diagnostic guidelines for Alzheimer’s disease: Preclinal stages, mild cognitive impairment, and dementia

[5] Annual Wellness Visits and Early Dementia Diagnosis Among Older Adults Receiving Medicare Benefits