Geography May Matter in Dementia Diagnosis: Daily Dose

Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

Last week, we reported on a study published in Alzheimer's & Dementia: The Journal of the Alzheimer's Association that explored how the diagnosis of Alzheimer disease and related dementias (ADRD) varies across different US regions.

The study

Researchers analyzed data from 4.8 million Medicare beneficiaries aged 66 years and older in 2019 across 306 hospital referral regions (HRR), a geographic identification tool developed for the Dartmouth Atlas of Health Care and used routinely in research. A new diagnosis of ADRD was documented for 143 029 (3%) of participants during 2019 and ranged from 4% to as high as 14%, depending on geographic location of HRR.

The findings

Results showed that the likelihood of receiving a diagnosis of ADRD varied by 2-fold based on place of residence. The association was consistent after multivariable adjustment for potential underlying individual risk factors, including education level, smoking rates, obesity, and diabetes.

Based on unadjusted analyses the research team found the disparity in new ADRD diagnosis rate across HRRs was greatest among the youngest group of older adults (ie, 23.2/100 among those aged 85 years and older and more than 10-fold lower [2.1/100] among adults aged 66 to 74 years) and among those who identified as Black/Hispanic vs those who identified as White/Other [6.5 vs 9.0/100]).

Authors' comment

"Variation in ADRD diagnosis raises important questions regarding differences in access and health care practices that may drive excess variability in ADRD detection and whether such differences translate into meaningful differences in outcomes."

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