Zhang Xiaodan, Witteveen-Lane Martin, Skovira Christine, Dave Aakash A, Jones Jeffrey S, McNeely Erin R, Lawrence Michael R, Morgan David G, Chesla Dave, Chen Bin
Department of Pediatrics and Human Development Michigan State University Grand Rapids Michigan USA.
Office of Research Corewell Health West Michigan Grand Rapids Michigan USA.
Alzheimers Dement (N Y). 2024 Aug 12;10(3):e12495. doi: 10.1002/trc2.12495. eCollection 2024 Jul-Sep.
Mild cognitive impairment (MCI) is a significant public health concern and a potential precursor to Alzheimer's disease (AD). This study leverages electronic health record (EHR) data to explore rural-urban differences in MCI incidence, risk factors, and healthcare navigation in West Michigan.
Analysis was conducted on 1,528,464 patients from Corewell Health West, using face-to-face encounters between 1/1/2015 and 7/31/2022. MCI cases were identified using International Classification of Diseases (ICD) codes, focusing on patients aged 45+ without prior MCI, dementia, or AD diagnoses. Incidence rates, cumulative incidences, primary care physicians (PCPs), and neuropsychology referral outcomes were examined across rural and urban areas. Risk factors were evaluated through univariate and multivariate Cox regression analyses. The geographic distribution of patient counts, hospital locations, and neurology department referrals were examined.
Among 423,592 patients, a higher MCI incidence rate was observed in urban settings compared to rural settings (3.83 vs. 3.22 per 1,000 person-years). However, sensitivity analysis revealed higher incidence rates in rural areas when including patients who progressed directly to dementia. Urban patients demonstrated higher rates of referrals to and completion of neurological services. While the risk factors for MCI were largely similar across urban and rural populations, urban-specific factors for incident MCI are hearing loss, inflammatory bowel disease, obstructive sleep apnea, insomnia, being African American, and being underweight. Common risk factors include diabetes, intracranial injury, cerebrovascular disease, coronary artery disease, stroke, Parkinson's disease, epilepsy, chronic obstructive pulmonary disease, depression, and increased age. Lower risk was associated with being female, having a higher body mass index, and having a higher diastolic blood pressure.
This study highlights rural-urban differences in MCI incidence and access to care, suggesting potential underdiagnosis in rural areas likely due to reduced access to specialists. Future research should explore socioeconomic, environmental, and lifestyle determinants of MCI to refine prevention and management strategies across geographic settings.
Leveraged EHRs to explore rural-urban differences in MCI in West Michigan.Revealed a significant underdiagnosis of MCI, especially in rural areas.Observed lower rates of neurological referrals and completions for rural patients.Identified risk factors specific to rural and urban populations.
轻度认知障碍（MCI）是一个重大的公共卫生问题，也是阿尔茨海默病（AD）的潜在先兆。本研究利用电子健康记录（EHR）数据，探讨密歇根州西部城乡在MCI发病率、危险因素及医疗保健导航方面的差异。
对Corewell Health West的1,528,464名患者进行分析，数据来源于2015年1月1日至2022年7月31日期间的面对面诊疗记录。使用国际疾病分类（ICD）编码识别MCI病例，重点关注年龄在45岁及以上、既往无MCI、痴呆或AD诊断的患者。对城乡地区的发病率、累积发病率、初级保健医生（PCP）以及神经心理学转诊结果进行了检查。通过单因素和多因素Cox回归分析评估危险因素。研究了患者数量的地理分布、医院位置以及神经内科转诊情况。
在423,592名患者中，城市地区的MCI发病率高于农村地区（每1000人年分别为3.83例和3.22例）。然而，敏感性分析显示，纳入直接进展为痴呆的患者后，农村地区的发病率更高。城市患者的神经科服务转诊率和完成率更高。虽然城乡人群中MCI的危险因素基本相似，但城市MCI发病的特定因素包括听力损失、炎症性肠病、阻塞性睡眠呼吸暂停、失眠、非裔美国人身份和体重过轻。常见危险因素包括糖尿病、颅内损伤、脑血管疾病、冠状动脉疾病、中风、帕金森病、癫痫、慢性阻塞性肺疾病、抑郁症以及年龄增长。女性、较高的体重指数和较高的舒张压与较低风险相关。
本研究突出了城乡在MCI发病率和医疗服务可及性方面的差异，表明农村地区可能存在潜在的诊断不足，这可能是由于专科医生可及性降低所致。未来的研究应探索MCI的社会经济、环境和生活方式决定因素，以完善不同地理区域的预防和管理策略。
利用电子健康记录探索密歇根州西部城乡在MCI方面的差异。揭示了MCI存在显著的诊断不足，尤其是在农村地区。观察到农村患者的神经科转诊率和完成率较低。确定了城乡人群特有的危险因素。
