state in 2019, the most recent year for which state-by-state data are available. This information was obtained from death certificates and reflects the condition identified by the physician as the underlying cause of death. The table also provides annual mortality rates by state to compare the risk of death due to Alzheimer’s disease across states with varying population sizes. For the United States as a whole, in 2019, the mortality rate for Alzheimer’s disease was 37.0 deaths per 100,000 people.A7,360 Alzheimer’s Death Rates As shown in Figure 8, the rate of deaths due to Alzheimer’s — that is, the number of Alzheimer’s deaths per number of persons in the population — has risen substantially since 2000.360 Table 6 shows that the rate of death from Alzheimer’s increases dramatically with age, especially after age 65.A7,360 The increase in the Alzheimer’s death rate over time has disproportionately affected the oldest-old.375 Between 2000 and 2019, the death rate from Alzheimer’s increased 33% for people age 65 to 74, but increased 51% for people age 75 to 84 and 78% for people age 85 and older.360 A report by the CDC determined that even after adjusting for changes over time in the specific ages of persons within these age groups, the annual Alzheimer’s death rate in the United States increased substantially between 1999 and 2014.376 Therefore, the advancing average age of the Created from data from the National Center for Health Statistics.360 U.S. Annual Alzheimer’s Death Rate (per 100,000 People) by only explanation for the increase in Alzheimer’s death rates. Other possible reasons include fewer deaths from other common causes of death in old age such as heart disease and stroke; increased clinical recognition of and formal diagnosis of Alzheimer’s dementia; and increased reporting of Alzheimer’s as a cause of death by physicians and others who complete death certificates.376 Duration of Illness from Diagnosis to Death Studies indicate that people age 65 and older survive an average of four to eight years after a diagnosis of Alzheimer’s dementia, yet some live as long as 20 years with Alzheimer’s dementia.10-18 This reflects the slow, insidious and uncertain progression of Alzheimer’s. A person who lives from age 70 to age 80 with Alzheimer’s dementia will spend an average of 40% of this time in the severe stage.372 Much of this time will be spent in a nursing home. At age 80, approximately 75% of people with Alzheimer’s dementia live in a nursing home compared with only 4% of the general population age 80.372 In all, an estimated two-thirds of those who die of dementia do so in nursing homes, compared with 20% of people with cancer and 28% of people dying from all other conditions.377 The Burden of Alzheimer’s Disease The long duration of illness before death contributes significantly to the public health impact of Alzheimer’s disease because much of that time is spent in a state of severe disability and dependence. Scientists have developed methods to attempt to measure and compare the burden of different diseases on a population in a way that takes into account not only the number of people with the condition, but also the number of years of life lost due to that disease and the number of healthy years of life lost by virtue of being in a state of disability. One measure of disease burden is called disability-adjusted life years (DALYs), which is the sum of the number of years of life lost (YLLs) due to premature mortality and the number of years lived with disability (YLDs), totaled across all those with the disease or injury. These measures indicate that Alzheimer’s is a very burdensome disease, not only to the individuals with the disease, but also to their families and informal caregivers, and that the burden of Alzheimer’s has increased more dramatically in the United States than the burden of other diseases in recent years. According to the most recent Global Burden of Disease classification system, Alzheimer’s disease rose from the 12th most burdensome disease or injury in the United States in 1990 to the sixth in 2016 in terms of DALYs. In 2016, Alzheimer’s disease was the fourth highest disease or injury in terms of YLLs and the 19th in terms of YLDs.361 These estimates should be interpreted with consideration of challenges in the availability of data across time and place378 and the incorporation of disability. These Alzheimer’s burden estimates use different sources for each state in a given year, and a specific source of data may differ in data included across years. Models used to generate these estimates of Alzheimer’s burden assume a year lived with disability counts as less than a year lived without disability.379 Models do not account for the context in which disability is experienced, including social support and economic resources,380 which may vary widely. These variations in data sources and consideration of disability may limit the value of these metrics and the comparability of Alzheimer’s estimates across states and across years. 36 Looking to the Future Taken together, these statistics indicate that not only is Alzheimer’s disease responsible for the deaths of more and more Americans, but also that the disease is contributing to more and more cases of poor health and disability in the United States. Most of the statistics in this section come from before the COVID-19 pandemic. We