Alzheimer's disease mortality high in rural areas in South: 1999‐2019. (31st December 2021)

• Record Type: Journal Article
• Authors: Kulshreshtha, Ambar; Ramer, Stephanie; Cato, Sarah; Hajjar, Ihab
• Is Part Of: Alzheimer's & dementia. Volume 17:(2021)Supplement 10
• Page Start: n/a
• Page End: n/a
• Publication Date: 2021-12-31
• Subjects: Alzheimer's disease -- Periodicals; Alzheimer Disease -- Periodicals; Dementia -- Periodicals; Démence; Maladie d'Alzheimer; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 616.83
• DOI: 10.1002/alz.054933
• Languages: English
• ISSNs: 1552-5260

Abstract

Abstract: Background: Urban‐rural differentials exist in the United States for both socio‐economic and cultural reasons. Geographic variation in Alzheimer's mortality exist, but how it applies to specific urbanization levels has not been examined previously. We sought to describe the pattern and magnitude of urban‐rural variations in Alzheimer's mortality in the United States. Methods: We used data from the National Center for Health Statistics to examine trends in Alzheimer's death rates (ICD‐10 codes G30) between 1999 and 2019 by urbanization levels. Alzheimer's mortality was defined as death from Alzheimer's in over the age of 65 years using data from death certificates. Urbanization classification is per 2013 NCHS definitions. Crude and age‐adjusted changes in Alzheimer's mortality rates were calculated in the overall population and in specific urbanization groups: in large and medium metros (urban); and non‐metros (rural). We also examined differences by race and sex. Poisson regression was used to model data. Results: From 1999‐2019, the age‐adjusted mortality rate from Alzheimer's has increased significantly from 16 to 30 deaths per 100, 000, an 88% increase. Significant disparities by urbanization and census region exist. Mortality rates are highest in the rural areas in the East South‐Central region, where the death rate from Alzheimer's is 274 per 100, 000 in those over 65. Mortality rates are lowest in urban areas in the Mid‐Atlantic region, where the death rate is 86 per 100, 000. Trends over time show a widening disparity across region and urbanization. Women had higher age‐adjusted AD mortality rates than men, regardless of metro area or race. Conclusions: Rural areas particularly in South are experiencing a disproportionate burden of Alzheimer's disease mortality. The reason for this trend might be manifold and related to access to primary care, timely diagnosis, and the rising proportion of older Americans living in these areas. Identifying and understanding the underlying causes of disparities in AD mortality among communities is key in designing targeted public health policies and interventions to curb the epidemic.