A recent study carried out by scientists from the University of Michigan suggests that where you live may be a major factor in whether or not you may develop Alzheimer’s disease and dementia. This is because access to new Alzheimer’s and dementia treatments may be geographically dependent. Despite the availability of innovative medications, the likelihood of receiving a diagnosis varies significantly across the United States, even when considering various factors.
The study revealed even more pronounced regional disparities in dementia diagnosis rates among younger individuals (66-74) and Black or Hispanic populations. In certain areas of the United States, individuals in these groups could be twice as likely to receive a diagnosis compared to those in other regions.
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The researchers focused on regional differences in “diagnostic intensity” of dementia – the kind of difference that exists even after all kinds of dementia risk factors and regional differences in population and health care are taken into account. Performed by a team based at the University of Michigan, it’s published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association.
“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,” said Julie Bynum, M.D., M.P.H., the U-M Health geriatrician and health care researcher who led the study.
“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,” added Bynum, a professor of internal medicine at the U-M Medical School. “But the good news is, these are things we can act on once we know where to look.”
Bynum and her colleagues at U-M and Dartmouth analyzed data from 4.8 million Medicare beneficiaries over 66 in 2019. They found that while nearly 7 million Americans have a dementia diagnosis, millions more likely exhibit symptoms without a formal diagnosis. A confirmed diagnosis is crucial for accessing specialized care and support, even for those ineligible for new treatments or diagnostic tools. Insurance coverage for these resources often hinges on a formal diagnosis.
In all, 143,029 of the people in the total population used in the study were newly diagnosed with Alzheimer’s or another form of dementia in 2019. The rest of the 356,656 people who had that diagnosis in this population had been diagnosed before 2019. That means that overall, said the researchers, about 7% of people covered by traditional Medicare have a dementia diagnosis at any given time, and 3% of this population is diagnosed each year, with an average age at diagnosis of about 83 years.
Bynum suggests that regional variations in clinical practices, such as screening frequency and specialist availability, may contribute to the observed differences in dementia diagnosis rates. Cultural and personal factors, like the likelihood of seeking care or proactively discussing memory concerns, could also play a role. While the study cannot definitively determine whether underdiagnosis or overdiagnosis is more prevalent, the areas with lower-than-expected rates can use these findings to identify potential barriers to diagnosis.”
