Is the risk of developing Alzheimer's disease really higher in rural areas? A multilevel longitudinal study of 261, 669 Australians aged 45 years and older tracked over 11 years. (November 2018)

• Record Type: Journal Article
• Authors: Astell-Burt, Thomas; Feng, Xiaoqi
• Is Part Of: Health & place. Volume 54(2018:Nov.)
• Page Start: 132
• Page End: 137
• Publication Date: 2018-11
• Subjects: Alzheimer's disease -- Disadvantage -- Environmental epidemiology: longitudinal studies -- Remoteness; Health -- Social aspects -- Periodicals; Health services accessibility -- Periodicals; Public health -- Periodicals; Political planning -- Periodicals; Social medicine -- Periodicals; Epidemiology -- Periodicals; Health Policy -- Periodicals; Health Services Accessibility -- Periodicals; Public Health -- Periodicals; Public Policy -- Periodicals; Sociology, Medical -- Periodicals; Épidémiologie -- Périodiques; Politique sanitaire -- Périodiques; Santé, Services de -- Accessibilité -- Périodiques; Health services accessibility; Health -- Social aspects; Political planning; Public health; Social medicine; Periodicals; 613
• DOI: 10.1016/j.healthplace.2018.09.003
• Languages: English
• ISSNs: 1353-8292

Abstract

Abstract: Cross-sectional studies of Alzheimer's disease tend to report higher risk in 'rural' areas. Multilevel longitudinal analysis of 261, 669 participants in the Sax Institute's 45 and Up Study was conducted, tracking incidence of Alzheimer's disease defined by the first cholinesterase inhibitor prescription via linked records from the Department of Human Services in Australia. Alzheimer's disease was diagnosed in 3046 participants over 11 years. Adjusting for age, gender, education, income and area disadvantage, Alzheimer's disease risk was lower in 'outer regional and remote areas' (incident rate ratio 0.81, 95%CI 0.67–0.97) compared with 'major cities'. Further research on environmental factors is warranted. Highlights: Prior research suggests a higher risk of Alzheimer's disease in rural areas. Most prior research has relied on cross-sectional data. Our longitudinal study finds higher Alzheimer's disease risk in major cities. Much spatial variation remained after adjusting for geographic remoteness. Future work needs to consider other potential environmental determinants.