Regional Disparities in Alzheimer's Disease and Related Dementia

Regional variation in diagnostic intensity of dementia among older U.S. adults: An observational study

The new study examines the geographic variation in the diagnostic intensity of Alzheimer's disease and related dementias (ADRD) across the United States among older adults. Using Medicare claims data from 2018-2019, the study found significant differences in the rate at which new ADRD cases are diagnosed depending on where individuals live. The variation in diagnostic intensity was particularly pronounced among younger age groups (66-74) and racial/ethnic minorities (Black and Hispanic populations). The study highlights that geographic location significantly influences the likelihood of receiving an ADRD diagnosis, suggesting that regional differences in healthcare practices and access could be driving these disparities.

Key Conclusions:

• Geographic Variation: There is significant regional variation in the diagnosis of ADRD across the U.S., with some areas diagnosing at much higher or lower rates than expected based on population demographics and risk factors.
• Impact on Minority Groups: The variation is most pronounced among Black, Hispanic, and younger age groups (66-74), suggesting disparities in access to or use of diagnostic services in these populations.
• Diagnostic Intensity: The intensity of diagnosing ADRD varies widely, with the likelihood of receiving a diagnosis being approximately two times higher in some regions compared to others.
• Potential for Underdiagnosis: Areas with lower diagnosis rates may indicate regions where there are barriers to diagnosis, leading to potential underdiagnosis of ADRD.
• Practice Variation: Differences in healthcare practices and possibly in patient behavior contribute to the observed variation, indicating that the issue is not solely due to population risk factors.

Shortcomings or Uncertainties:

• Data Limitations: The study is based on Medicare Fee-For-Service (FFS) claims data, which may not fully represent other populations, such as those in Medicare Advantage programs.
• Residual Confounding: Despite adjustments for various regional characteristics, there may still be unmeasured factors influencing the observed variation.
• Generalizability: Findings may not be generalizable to all demographics, especially younger populations or those not covered by Medicare.
• Potential Overdiagnosis: In regions with high diagnostic intensity, there could be a risk of overdiagnosis, particularly as new diagnostic tools and biomarkers become more widely used.

In summary, the study highlights the significant regional disparities in ADRD diagnosis across the U.S., which are influenced by a combination of population characteristics and healthcare practices. However, the unexplained variation and potential for overdiagnosis/underdiagnosis point to the need for further research and policy interventions to ensure equitable and accurate dementia care.

https://www.npr.org/2024/08/19/nx-s1-5080602/alzheimers-study-regional-differences-diagnosis-dementia

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