Medical Faculty and University Hospital Cologne, Cologne, Germany.
Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
J Alzheimers Dis. 2019;69(2):455-462. doi: 10.3233/JAD-190017.
Life in rural areas differs from life in urban areas not only in geographical conditions, but also in health care structure.
Our aim is to compare the diagnostic process and the management of dementia in rural and urban areas of Sweden.
We performed a cross-sectional study of patients with dementia living in rural (n = 16,428), intermediate (n = 18,033), and urban (n = 23,680) areas in Sweden including patients registered from 2007 through 2014 in the Swedish Dementia Registry (SveDem). Descriptive statistics are shown. Odds ratios with 95% CI are presented for basic diagnostic examinations in rural compared to intermediate and urban areas, adjusted for age, sex, type of care (primary versus specialist), and comorbidities. Analyses were also stratified for diagnostic care unit (primary versus specialist).
Patients who lived in rural areas were more likely to receive a complete basic examination, MMSE examination, Clock test, blood analysis, and neuro-imaging, compared to patients living in urban areas, and also compared to patients living in intermediate areas. Sex differences were seen in nearly all domains, with men receiving more diagnostic work-up than women. Stratified analyses show that in primary care, the complete basic examination is less frequently performed in urban and intermediate areas compared to rural areas.
There are differences in diagnostic work-up for dementia between rural, intermediate, and urban areas in Sweden. These results should be considered in future healthcare decisions to ensure equality of health care across rural and urban areas.
农村地区的生活不仅在地理条件上与城市地区不同，在医疗保健结构上也有所不同。
我们旨在比较瑞典农村和城市地区痴呆症的诊断过程和管理。
我们对 2007 年至 2014 年间在瑞典痴呆症登记处（SveDem）登记的居住在瑞典农村（n=16428）、中等（n=18033）和城市（n=23680）地区的痴呆症患者进行了横断面研究。显示描述性统计数据。对于农村地区与中等和城市地区相比的基本诊断检查，呈现了优势比及其 95%置信区间，调整了年龄、性别、护理类型（初级与专科）和合并症。还按诊断护理单位（初级与专科）进行了分层分析。
与居住在城市地区的患者相比，居住在农村地区的患者更有可能接受完整的基本检查、MMSE 检查、时钟测试、血液分析和神经影像学检查，与居住在中等地区的患者相比也是如此。在几乎所有领域都观察到了性别差异，男性接受的诊断检查比女性更多。分层分析显示，在初级保健中，与农村地区相比，城市和中等地区不太常进行完整的基本检查。
在瑞典，农村、中等和城市地区之间在痴呆症的诊断工作上存在差异。在未来的医疗保健决策中，应考虑这些结果，以确保农村和城市地区的医疗保健平等。
