Disparity in Incidence and Health Outcomes between Rural and Urban Patients with Alzheimers disease and related disorders

摘要 到2030年，超过20%的美国人口将至少达到65岁，这是发病率最高的年龄。 阿尔茨海默病和相关疾病（ADRD）开始增加。2014年，17%的人口生活在 农村地区已经超过65岁，这表明农村人口可能受到严重影响， 在当前和未来的几年里，ADRD。越来越多的证据表明，疾病负担的差异以及 生活在城市的老年人中存在卫生服务的可获得性、可获得性、可负担性和可接受性。 农村地区，可能导致城乡之间预期寿命差距不断扩大 社区.先前的研究发现，ADRD的患病率因性别、种族和民族而异，但 少数研究调查了居住在城市和农村的老年人在诊断和结果方面的差异。 地区研究与ADRD相关的农村健康差异的研究主要集中在以下问题上： 与获得护理有关，并表明农村地区的ADRD患者更有可能接受次优治疗。 健康护理我们对居住地如何影响诊断和后续治疗的认识存在差距。 老年ADRD患者的结局。了解生活在农村的ADRD老年人是否存在差异 这些领域可以对ADRD的风险因素产生重要的见解，影响ADRD经验的变量 与ADRD一起生活，以及可以更有效地管理它们的方法。的目的 应用，实现这一长期目标的第一步，是进行基于人口的研究， 分析以确定ADRD诊断发生率和患病率、医疗保健 使用和健康结果。这一建议的核心假设是， 患有ADRD的受益人将在其疾病过程的后期被诊断出来，并经历更差的健康状况 结果。这一假设是基于初步的工作，表明ADRD的患病率较低，但 在农村地区人口比例较高的州，ADRD的死亡率较高。到 为了达到这个目标，我们提出两个目标。首先，我们将比较诊断发病率和患病率， 生活在农村和城市社区的医疗保险受益人之间的ADRD。第二，我们将比较 和急性，疗养院和家庭医疗保健使用的轨迹在六年后的初步诊断， 农村和城市受益人之间的ADRD。我们建议研究按服务收费的医疗保险受益人， 2008-2015年整合医疗保险登记，索赔和居民评估数据。这项研究的结果有 对许多人来说都有好处。对于政策制定者来说，这项研究将使基于证据的政策成为可能。 旨在改善农村卫生保健的发展。对于农村卫生服务提供者，这项工作将推动努力， 改善ADRD筛查，以确保农村受益人得到及时诊断， 未来的不良后果。对于农村卫生系统，这些发现将有助于规划未来的需求， 了解我们现行制度在满足这一群体需求方面的差距。

ABSTRACT By 2030, over 20% of the US population will be at least 65 years old, the age at which incidence of Alzheimer's disease and related disorders (ADRD) begins to increase. In 2014, 17% of the population living in rural areas was already over the age of 65, suggesting that rural populations may be disproportionally affected by ADRD in current and coming years. There is growing evidence that disparities in disease burden as well as availability, accessibility, affordability, and acceptability of health services exist among older adults living in rural areas, likely contributing to the growing gap in life expectancy witnessed between urban and rural communities. Previous studies have found that ADRD prevalence rates vary by gender, race, and ethnicity, yet few studies have examined disparities in diagnosis and outcomes of older adults living in urban and rural areas. Studies that have examined rural health disparities related to ADRD have largely focused on issues related to access to care, and suggest that ADRD patients in rural areas are more likely to receive suboptimal healthcare. There is a gap in our knowledge on how place of residence influences diagnosis and subsequent outcomes of older adults with ADRD. Understanding if disparities exist for older adults with ADRD living in rural areas could yield important insights into the risk factors for ADRD, the variables influencing the experience of living with ADRD, and the methods by which they can be more effectively managed. The objective of this application, the first step toward this long-term goal, is to conduct a population based study and thorough analysis to identify if rural-urban disparities in the diagnostic incidence and prevalence of ADRD, healthcare utilization, and health outcomes exist. The central hypothesis of this proposal is that rural Medicare beneficiaries with ADRD will be diagnosed later in the course of their disease and experience worse health outcomes. This hypothesis is based on preliminary work that shows the prevalence rate of ADRD is lower, yet the mortality rate due to ADRD is higher in states with a higher share of its population living in rural areas. To achieve this objective, we propose two aims. First, we will compare the diagnostic incidence and prevalence of ADRD between Medicare beneficiaries living in rural and urban communities. Second, we will compare survival and trajectories of acute, nursing home and home health care use in six years following the initial diagnosis of ADRD between rural and urban beneficiaries. We propose to study fee-for-service Medicare beneficiaries in 2008-2015 integrating Medicare enrollment, claims, and resident assessment data. Findings of this study have several expected benefits for many. For policy makers, this research will enable evidence-based policy development aimed at improving rural health care. For rural health providers, this work will drive efforts to improve ADRD screening in order to ensure rural beneficiaries receive a timely diagnosis, which may delay future adverse outcomes. For rural health systems, these findings will help plan for future demand and understand gaps in our current system in meeting this population's needs.