Division of Epidemiology, College of Public Health, Ohio State University, Columbus, OH, USA.
Department of Neurology, College of Medicine, Ohio State University, Columbus, OH, USA.
J Alzheimers Dis. 2024;101(1):99-109. doi: 10.3233/JAD-240528.
Alzheimer's disease and related dementias (ADRD) prevalence varies geographically in the United States.
To assess whether the geographic variation of ADRD in Central Appalachia is explained by county-level sociodemographics or access to care.
Centers for Medicare and Medicaid Services Public Use Files from 2015- 2018 were used to estimate county-level ADRD prevalence among all fee-for-service (FFS) beneficiaries with≥1 inpatient, skilled nursing facility, home health agency, hospital outpatient or Carrier claim with a valid ADRD ICD-9/10 code over three-years in Central Appalachia (Kentucky, North Carolina, Ohio, Tennessee, Virginia, and West Virginia). Negative binomial regression was used to estimate prevalence overall, by Appalachian/non-Appalachian designation, and by rural/urban classification. Models were then adjusted for county-level: 1) FFS demographics (age, gender, and Medicaid eligibility), comorbidities; 2) population sociodemographics (race/ethnicity, education, aging population distribution, and renter-occupied housing); and 3) diagnostic access (PCP visits, neurology visits, and imaging scans).
Across the 591 counties in the Central Appalachian region, the average prevalence of ADRD from 2015- 2018 was 11.8%. ADRD prevalence was modestly higher for Appalachian counties both overall (PR: 1.03; 95% CI: 1.02, 1.04) and after adjustment (PR: 1.02; 95% CI: 1.00, 1.03) compared to non-Appalachian counties. This difference was similar among rural and urban counties (p = 0.326) but varied by state (p = 0.004).
The relative variation in ADRD prevalence in the Appalachian region was smaller than hypothesized. The case mixture of the dual eligible population, accuracy of the outcome measurement, and impact of educational attainment in this region may contribute to this observation.
美国阿尔茨海默病和相关痴呆症（ADRD）的患病率在地理上存在差异。
评估阿巴拉契亚中部地区 ADRD 的地理差异是否可以用县级社会人口统计学或获得护理的情况来解释。
使用 2015-2018 年医疗保险和医疗补助服务中心公共使用文件，估计阿巴拉契亚中部地区（肯塔基州、北卡罗来纳州、俄亥俄州、田纳西州、弗吉尼亚州和西弗吉尼亚州）所有按服务付费（FFS）受益人的县级 ADRD 患病率，这些受益人在三年内至少有一次住院、熟练护理机构、家庭保健机构、医院门诊或有有效 ADRD ICD-9/10 代码的承运人索赔。使用负二项回归总体估计患病率，并按阿巴拉契亚/非阿巴拉契亚指定和农村/城市分类进行估计。然后，根据县级情况对模型进行调整：1）FFS 人口统计学（年龄、性别和医疗补助资格）、合并症；2）人口社会人口统计学（种族/族裔、教育、老龄化人口分布和租户居住住房）；3）诊断机会（初级保健医生就诊、神经科就诊和影像学检查）。
在阿巴拉契亚中部地区的 591 个县中，2015-2018 年 ADRD 的平均患病率为 11.8%。总体而言，阿巴拉契亚县的 ADRD 患病率略高（PR：1.03；95%CI：1.02，1.04），调整后（PR：1.02；95%CI：1.00，1.03）也是如此与非阿巴拉契亚县相比。在农村和城市县之间，这一差异相似（p=0.326），但因州而异（p=0.004）。
阿巴拉契亚地区 ADRD 患病率的相对差异小于假设。双重合格人群的病例组合、结果测量的准确性以及该地区教育程度的影响可能导致了这一观察结果。
