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Map reveals America's Alzheimer's hotspots by region
Your odds of getting Alzheimer's disease could come down to your zip code, a new study finds.
Researchers from the University of Michigan found someone in one town in the same state could have a two-times higher risk of being diagnosed with the memory-robbing disease compared to someone a few towns over.
The inner-state disparities are likely the result of dementias being missed, the team argued. They blamed variations in screening and testing, patchy healthcare and education, as well as differences in people's willingness to see a doctor.
The general concentration of Alzheimer’s diagnoses was in the South, along the so-called ‘stroke belt’, where the population has a greater rate of cardiovascular risk factors.
But even there, there was a patchwork quality that researchers said could reflect disparate levels of general awareness of health and signs of disease to look for.
Dr Julie Bynum, the UM Health geriatrician and healthcare researcher who led the study, said: ‘These findings go beyond demographic and population-level differences in risk, and indicate that there are health system-level differences that could be targeted and remediated.
‘The message is clear: from place to place, the likelihood of getting your dementia diagnosed varies, and that may happen because of everything from practice norms for health care providers to individual patients’ knowledge and care-seeking behavior.’
This patchwork could reflect populations that go undiagnosed and undercared for, as well as differences in how doctors across regions practice.
Doctors in some areas may be more proactive in diagnosing Alzheimer's than those in other areas, for instance.
It could also mean that patients in some areas are less likely to visit the doctor than people in others, and therefore go undiagnosed.
With the number of Alzheimer’s patients expected to spike from its current 6.7 million to nearly 13 million by 2050, addressing the factors that cause zip code-by-zip code disparities could have a massive impact on public health, the team of experts said.
The researchers who conducted the study started by analyzing 2018-2019 data from Medicare, the federal healthcare insurance program for seniors 65 and up, to identify cases of Alzheimer's and other forms of dementia.
The number of Alzheimer’s patients is expected to spike from its current 6.7 million to nearly 13 million by 2050
Dr Bynum said: ‘The goal these days should be to identify people with cognitive issues earlier, yet our data show the younger age group of Medicare participants is the one with the most variation.’
‘For communities and health systems, this should be a call to action for spreading knowledge and increasing efforts to make services available to people.’
They looked at 306 different regions across the US where hospitals perform highly specialized care for Medicare enrollees.
Out of the nearly 4.9 million seniors studied, 419,646 had Alzheimer's or another form of dementia, and about 143,000 of them were diagnosed in 2019.
Then, they created a way to determine the actual number of cases diagnosed in 2019 and compared them to the number they would expect to see based on statistical models.
The allowed the researchers to see if some regions were diagnosing more or fewer cases than expected.
They also looked at broader factors such as the average highest level of education in an area, obesity and smoking rates, and how close people lived to research centers, which could affect how often people are diagnosed.
The results were presented as a ratio comparing the actual number of diagnoses made in a region and the number of diagnoses that would be expected based on age and health status of a population.
If the ratio is higher than 1.0, it means more people are being diagnosed than expected, indicating high diagnostic intensity
The prevalence of diagnosed dementia ranged from as low as four percent to as high as 14 percent, depending on the hospital referral region, and the rate of new dementia diagnoses in 2019 ranged from 1.7 percent to 5.4 percent.
The highest number of Alzheimer's and dementia cases cases were found in the South along the ‘stroke belt’, but there was some variation.
Areas of Mississippi, for instance, had fewer cases than researchers expected, while central Texas had way more.
That variability was nationwide, and the gaps between neighboring regions could be very wide.
For instance, the diagnosis intensity in Portland, Oregon, was 1.2, meaning more diagnoses were made than expected.
But in Bend, Oregon, right next door, the diagnosis intensity was 0.8, indicating that there were fewer diagnoses than expected.
The researchers did not give a region-by-region reasoning for differences in documented versus expected cases, but said they could come down to demographic differences such as average ages and races of the populations there, access to screening, and whether a person knows what signs to be on alert for.
The above graph shows the estimated projection of Alzheimer's disease patients in the US through 2060.
Those gaps were not unique to Oregon. They could be seen on the researchers’ map nationwide.
The Gainsville, Florida, diagnosis intensity measured at about 1.1. But just south in more rural Ocala, the diagnosis intensity was 0.9.
And in Providence, Rhode Island, the rate was 0.8. But in Hartford, Connecticut, fewer than 100 miles west, that rate was 1.1.
Their findings were published in Alzheimer's & Dementia: The Journal of the Alzheimer's Association.
Some of the region-level Alzheimer’s rates could also be undercounts, as people in different parts of the country face barriers to receiving care and correct diagnoses.
The researchers concluded: ‘These findings have important implications for future strategies aimed at improving case-finding among these groups.
‘Furthermore, these findings raise important questions regarding the degree to which differences in access and health care practices may drive excess variability in ADRD detection.’