{
  "generated_by": "claude-code",
  "n_studies_analysed": 43,
  "results": [
    {
      "id": "S1",
      "level": "state",
      "status": "analysed",
      "exposure": "pm25_avg_ugm3",
      "outcome": "alz_deaths_per_100k",
      "n": 51,
      "pearson": {
        "r": -0.00011123744600365344,
        "p": 0.9993818790932204
      },
      "spearman": {
        "rho": 0.07245920359383902,
        "p": 0.6133490052378554
      },
      "partial": {
        "controls": [
          "median_household_income",
          "primary_care_physicians_per_100k"
        ],
        "r": -0.09722953468667553,
        "p": 0.4972932906821034,
        "n": 51
      },
      "divergence_flag": false,
      "sign_flip_vs_literature": false,
      "modelled_vs_measured": {
        "exposure": "measured/administrative -- America's Health Rankings, Air Pollution (source: EPA), 2022-2024 average",
        "outcome": "measured/administrative -- Alzheimer's Association 2025 Facts and Figures, Table 6 (NCHS)"
      },
      "verdict": "Raw negligible negative association (r=-0.00, n=51, p=0.999, not distinguishable from zero at p<0.05). Because the raw association was not significant to begin with, the partial r=-0.10 (p=0.497) controlling for median_household_income + primary_care_physicians_per_100k has no real baseline effect to explain away -- reported for completeness, not as a finding. Ecological correlation only: does not show the exposure causes or prevents Alzheimer's at the individual level."
    },
    {
      "id": "S2",
      "level": "state",
      "status": "analysed",
      "exposure": "pct_hearing_loss",
      "outcome": "alz_prevalence_65plus_pct",
      "n": 51,
      "pearson": {
        "r": -0.6109168102824885,
        "p": 1.9260129405415e-06
      },
      "spearman": {
        "rho": -0.5952755374421868,
        "p": 4.077752535566048e-06
      },
      "partial": {
        "controls": [
          "pct_65plus"
        ],
        "r": -0.5872970313338384,
        "p": 5.889546839317678e-06,
        "n": 51
      },
      "divergence_flag": false,
      "sign_flip_vs_literature": true,
      "modelled_vs_measured": {
        "exposure": "measured/administrative -- CDC/NCHS, Any Hearing Loss by State, National Health Interview Survey 2014-2016 (Blackwell & Norris)",
        "outcome": "modelled/derived -- Alzheimer's Association 2025 Alzheimer's Disease Facts and Figures, Table 5 (data from Dhana et al., state/county prevalence model)"
      },
      "verdict": "Raw strong negative association (r=-0.61, n=51, p=1.93e-06). Controlling for pct_65plus, the partial r is -0.59 (p=5.89e-06) and the association SURVIVES -- not explained away by pct_65plus alone, though this remains an ecological (group-level) association, not evidence of an individual-level effect. SIGN FLIP vs. established literature (hearing loss is a well-established (Lancet Commission) modifiable risk factor; more hearing loss is expected to track with more dementia, not less) -- read this as a measurement/diagnostic-capacity finding about the data, not a discovery about risk. Ecological correlation only: does not show the exposure causes or prevents Alzheimer's at the individual level."
    },
    {
      "id": "S3",
      "level": "state",
      "status": "analysed",
      "exposure": "pct_diabetes",
      "outcome": "alz_prevalence_65plus_pct",
      "n": 50,
      "pearson": {
        "r": 0.1342912980357308,
        "p": 0.35248181439568715
      },
      "spearman": {
        "rho": 0.3987834041804613,
        "p": 0.004123601742702613
      },
      "partial": {
        "controls": [
          "pct_obesity",
          "pct_hypertension",
          "pct_physical_inactivity"
        ],
        "r": 0.23656007208109234,
        "p": 0.10548952095662356,
        "n": 48
      },
      "divergence_flag": true,
      "sign_flip_vs_literature": false,
      "modelled_vs_measured": {
        "exposure": "measured/administrative -- KFF State Health Facts, Adults with Diagnosed Diabetes (CDC BRFSS)",
        "outcome": "modelled/derived -- Alzheimer's Association 2025 Alzheimer's Disease Facts and Figures, Table 5 (data from Dhana et al., state/county prevalence model)"
      },
      "verdict": "Raw weak positive association (r=0.13, n=50, p=0.352, not distinguishable from zero at p<0.05). Pearson (r=0.13) and Spearman (rho=0.40) disagree materially -- likely non-linear or outlier-driven; neither number should be read alone. Because the raw association was not significant to begin with, the partial r=0.24 (p=0.105) controlling for pct_obesity + pct_hypertension + pct_physical_inactivity has no real baseline effect to explain away -- reported for completeness, not as a finding. Ecological correlation only: does not show the exposure causes or prevents Alzheimer's at the individual level."
    },
    {
      "id": "S4",
      "level": "state",
      "status": "analysed",
      "exposure": "pct_bachelors_plus",
      "outcome": "alz_deaths_per_100k",
      "n": 51,
      "pearson": {
        "r": -0.5800831656620364,
        "p": 8.143920969984728e-06
      },
      "spearman": {
        "rho": -0.42655744393261735,
        "p": 0.0018004464799553624
      },
      "partial": {
        "controls": [
          "pct_65plus",
          "median_household_income"
        ],
        "r": -0.25483116038437575,
        "p": 0.07112706822618563,
        "n": 51
      },
      "divergence_flag": false,
      "sign_flip_vs_literature": false,
      "modelled_vs_measured": {
        "exposure": "measured/administrative -- U.S. Census Bureau, ACS 2023 1-Year Estimates, GCT1502",
        "outcome": "measured/administrative -- Alzheimer's Association 2025 Facts and Figures, Table 6 (NCHS)"
      },
      "verdict": "Raw strong negative association (r=-0.58, n=51, p=8.14e-06). Controlling for pct_65plus + median_household_income, the partial r falls to -0.25 (p=0.0711) -- well under half the raw value, so the raw association largely COLLAPSES and is consistent with it measuring pct_65plus + median_household_income rather than pct_bachelors_plus itself. Ecological correlation only: does not show the exposure causes or prevents Alzheimer's at the individual level."
    },
    {
      "id": "S5",
      "level": "state",
      "status": "analysed",
      "exposure": "neurologists_per_100k",
      "outcome": "alz_count_65plus",
      "n": 51,
      "pearson": {
        "r": 0.009500263740939176,
        "p": 0.9472465141203441
      },
      "spearman": {
        "rho": 0.20682675714509233,
        "p": 0.14533204386959098
      },
      "partial": {
        "controls": [
          "pop_total"
        ],
        "r": 0.11885729578977546,
        "p": 0.4061327231545895,
        "n": 51
      },
      "divergence_flag": false,
      "sign_flip_vs_literature": false,
      "modelled_vs_measured": {
        "exposure": "measured/administrative -- American Academy of Neurology, 2025 Member Demographics Report, Table 10b",
        "outcome": "modelled/derived -- Alzheimer's Association 2025 Alzheimer's Disease Facts and Figures, Table 5"
      },
      "verdict": "Raw negligible positive association (r=0.01, n=51, p=0.947, not distinguishable from zero at p<0.05). Because the raw association was not significant to begin with, the partial r=0.12 (p=0.406) controlling for pop_total has no real baseline effect to explain away -- reported for completeness, not as a finding. Ecological correlation only: does not show the exposure causes or prevents Alzheimer's at the individual level."
    },
    {
      "id": "S6",
      "level": "state",
      "status": "analysed",
      "exposure": "geriatricians_count",
      "outcome": "alz_deaths_per_100k",
      "n": 51,
      "pearson": {
        "r": -0.2848194693559779,
        "p": 0.042789069619458
      },
      "spearman": {
        "rho": -0.27068247674353485,
        "p": 0.05471020436928281
      },
      "partial": {
        "controls": [
          "pop_total"
        ],
        "r": -0.40924739359143725,
        "p": 0.0028641878293884124,
        "n": 51
      },
      "divergence_flag": false,
      "sign_flip_vs_literature": false,
      "modelled_vs_measured": {
        "exposure": "measured/administrative -- Alzheimer's Association 2025 Facts and Figures, Table 14, citing American Geriatrics Society",
        "outcome": "measured/administrative -- Alzheimer's Association 2025 Facts and Figures, Table 6 (NCHS)"
      },
      "verdict": "Raw weak negative association (r=-0.28, n=51, p=0.0428). Controlling for pop_total, the partial r is -0.41 (p=0.00286) and the association SURVIVES -- not explained away by pop_total alone, though this remains an ecological (group-level) association, not evidence of an individual-level effect. Ecological correlation only: does not show the exposure causes or prevents Alzheimer's at the individual level."
    },
    {
      "id": "S7",
      "level": "state",
      "status": "analysed",
      "exposure": "medicaid_ltss_spend_per_capita",
      "outcome": "alz_deaths_per_100k",
      "n": 51,
      "pearson": {
        "r": -0.06437982382150421,
        "p": 0.653552895908265
      },
      "spearman": {
        "rho": -0.009141305636056191,
        "p": 0.9492370931430291
      },
      "partial": {
        "controls": [
          "median_household_income",
          "pct_65plus"
        ],
        "r": -0.11763459436576826,
        "p": 0.4110128955185932,
        "n": 51
      },
      "divergence_flag": false,
      "sign_flip_vs_literature": false,
      "modelled_vs_measured": {
        "exposure": "modelled/derived -- Derived by this project: medicaid_dementia_spend_total_usd / pop_total",
        "outcome": "measured/administrative -- Alzheimer's Association 2025 Facts and Figures, Table 6 (NCHS)"
      },
      "verdict": "Raw negligible negative association (r=-0.06, n=51, p=0.654, not distinguishable from zero at p<0.05). Because the raw association was not significant to begin with, the partial r=-0.12 (p=0.411) controlling for median_household_income + pct_65plus has no real baseline effect to explain away -- reported for completeness, not as a finding. Ecological correlation only: does not show the exposure causes or prevents Alzheimer's at the individual level."
    },
    {
      "id": "S8",
      "level": "state",
      "status": "analysed",
      "exposure": "alz_state_plan",
      "outcome": "alz_deaths_per_100k",
      "n": 51,
      "pearson": {
        "r": null,
        "p": null
      },
      "spearman": {
        "rho": null,
        "p": null
      },
      "partial": null,
      "divergence_flag": false,
      "sign_flip_vs_literature": false,
      "modelled_vs_measured": {
        "exposure": "measured/administrative -- Alzheimer's Impact Movement, State Alzheimer's Disease Plans",
        "outcome": "measured/administrative -- Alzheimer's Association 2025 Facts and Figures, Table 6 (NCHS)"
      },
      "verdict": "Exposure or outcome has zero variance across units (degenerate input, e.g. every row equal), so Pearson r is undefined -- not zero, undefined."
    },
    {
      "id": "S9",
      "level": "state",
      "status": "analysed",
      "exposure": "pct_rural",
      "outcome": "alz_deaths_per_100k",
      "n": 51,
      "pearson": {
        "r": 0.5384989563770812,
        "p": 4.578137219841772e-05
      },
      "spearman": {
        "rho": 0.48643450432266916,
        "p": 0.00029551590843711643
      },
      "partial": {
        "controls": [
          "pct_65plus",
          "median_household_income"
        ],
        "r": 0.2676027375985663,
        "p": 0.05763382069663114,
        "n": 51
      },
      "divergence_flag": false,
      "sign_flip_vs_literature": false,
      "modelled_vs_measured": {
        "exposure": "measured/administrative -- America's Health Rankings, Rural Population (Census ACS 1-Year)",
        "outcome": "measured/administrative -- Alzheimer's Association 2025 Facts and Figures, Table 6 (NCHS)"
      },
      "verdict": "Raw strong positive association (r=0.54, n=51, p=4.58e-05). Controlling for pct_65plus + median_household_income, the partial r falls to 0.27 (p=0.0576) -- well under half the raw value, so the raw association largely COLLAPSES and is consistent with it measuring pct_65plus + median_household_income rather than pct_rural itself. Ecological correlation only: does not show the exposure causes or prevents Alzheimer's at the individual level."
    },
    {
      "id": "S10",
      "level": "state",
      "status": "analysed",
      "exposure": "pct_uninsured",
      "outcome": "alz_prevalence_65plus_pct",
      "n": 51,
      "pearson": {
        "r": -0.06509478111405174,
        "p": 0.6499534126631332
      },
      "spearman": {
        "rho": 0.002310202071459471,
        "p": 0.987163273747758
      },
      "partial": null,
      "divergence_flag": false,
      "sign_flip_vs_literature": false,
      "modelled_vs_measured": {
        "exposure": "measured/administrative -- KFF State Health Facts, Health Insurance Coverage of the Total Population (ACS-based)",
        "outcome": "modelled/derived -- Alzheimer's Association 2025 Alzheimer's Disease Facts and Figures, Table 5 (data from Dhana et al., state/county prevalence model)"
      },
      "verdict": "Raw negligible negative association (r=-0.07, n=51, p=0.65, not distinguishable from zero at p<0.05). Triage names no single confounder column to partial on; read the raw coefficient with the card's stated caveats. Ecological correlation only: does not show the exposure causes or prevents Alzheimer's at the individual level."
    },
    {
      "id": "S11",
      "level": "state",
      "status": "analysed",
      "exposure": "unpaid_caregiver_hours_millions",
      "outcome": "alz_count_65plus",
      "n": 51,
      "pearson": {
        "r": 0.9443508377483858,
        "p": 2.6132475869074657e-25
      },
      "spearman": {
        "rho": 0.9671259533233916,
        "p": 8.518187886463427e-31
      },
      "partial": {
        "controls": [
          "pop_total"
        ],
        "r": -0.0458042561677588,
        "p": 0.7496006369590434,
        "n": 51
      },
      "divergence_flag": false,
      "sign_flip_vs_literature": false,
      "modelled_vs_measured": {
        "exposure": "measured/administrative -- Alzheimer's Association 2025 Facts and Figures, Table 10",
        "outcome": "modelled/derived -- Alzheimer's Association 2025 Alzheimer's Disease Facts and Figures, Table 5"
      },
      "verdict": "Raw strong positive association (r=0.94, n=51, p=2.61e-25). Controlling for pop_total, the partial r falls to -0.05 (p=0.75) -- well under half the raw value, so the raw association largely COLLAPSES and is consistent with it measuring pop_total rather than unpaid_caregiver_hours_millions itself. Ecological correlation only: does not show the exposure causes or prevents Alzheimer's at the individual level."
    },
    {
      "id": "S12",
      "level": "state",
      "status": "analysed",
      "exposure": "pct_depression",
      "outcome": "alz_prevalence_65plus_pct",
      "n": 51,
      "pearson": {
        "r": -0.366129061630702,
        "p": 0.008234393357232596
      },
      "spearman": {
        "rho": -0.4910303344952463,
        "p": 0.0002536441474711813
      },
      "partial": null,
      "divergence_flag": false,
      "sign_flip_vs_literature": false,
      "modelled_vs_measured": {
        "exposure": "measured/administrative -- America's Health Rankings, Depression (CDC BRFSS)",
        "outcome": "modelled/derived -- Alzheimer's Association 2025 Alzheimer's Disease Facts and Figures, Table 5 (data from Dhana et al., state/county prevalence model)"
      },
      "verdict": "Raw moderate negative association (r=-0.37, n=51, p=0.00823). Triage names no single confounder column to partial on; read the raw coefficient with the card's stated caveats. Ecological correlation only: does not show the exposure causes or prevents Alzheimer's at the individual level."
    },
    {
      "id": "B1",
      "level": "state",
      "status": "analysed",
      "exposure": "pct_race_black",
      "outcome": "alz_deaths_per_100k",
      "n": 51,
      "pearson": {
        "r": -0.09972856617702863,
        "p": 0.48624920305310915
      },
      "spearman": {
        "rho": -0.06487452778960286,
        "p": 0.6510614489620412
      },
      "partial": null,
      "divergence_flag": false,
      "sign_flip_vs_literature": false,
      "modelled_vs_measured": {
        "exposure": "measured/administrative -- U.S. Census Bureau, ACS 2023 1-Year Estimates, GCT0202",
        "outcome": "measured/administrative -- Alzheimer's Association 2025 Facts and Figures, Table 6 (NCHS)"
      },
      "verdict": "Raw negligible negative association (r=-0.10, n=51, p=0.486, not distinguishable from zero at p<0.05). Triage names no single confounder column to partial on; read the raw coefficient with the card's stated caveats. Ecological correlation only: does not show the exposure causes or prevents Alzheimer's at the individual level."
    },
    {
      "id": "B2",
      "level": "state",
      "status": "analysed",
      "exposure": "pct_race_hispanic",
      "outcome": "alz_prevalence_65plus_pct",
      "n": 51,
      "pearson": {
        "r": 0.23845589851039653,
        "p": 0.09196867678766182
      },
      "spearman": {
        "rho": 0.33902544234557064,
        "p": 0.014947190238688533
      },
      "partial": null,
      "divergence_flag": false,
      "sign_flip_vs_literature": false,
      "modelled_vs_measured": {
        "exposure": "measured/administrative -- KFF State Health Facts, Distribution by Race/Ethnicity (ACS 1-Year Estimates)",
        "outcome": "modelled/derived -- Alzheimer's Association 2025 Alzheimer's Disease Facts and Figures, Table 5 (data from Dhana et al., state/county prevalence model)"
      },
      "verdict": "Raw weak positive association (r=0.24, n=51, p=0.092, not distinguishable from zero at p<0.05). Triage names no single confounder column to partial on; read the raw coefficient with the card's stated caveats. Ecological correlation only: does not show the exposure causes or prevents Alzheimer's at the individual level."
    },
    {
      "id": "B3",
      "level": "state",
      "status": "analysed",
      "exposure": "gini",
      "outcome": "alz_deaths_per_100k",
      "n": 51,
      "pearson": {
        "r": -0.25652924131618504,
        "p": 0.06920045733764385
      },
      "spearman": {
        "rho": -0.1798022315368623,
        "p": 0.20675794503012435
      },
      "partial": null,
      "divergence_flag": false,
      "sign_flip_vs_literature": false,
      "modelled_vs_measured": {
        "exposure": "measured/administrative -- Wikipedia 'List of U.S. states and territories by income inequality', citing Census ACS table B19083",
        "outcome": "measured/administrative -- Alzheimer's Association 2025 Facts and Figures, Table 6 (NCHS)"
      },
      "verdict": "Raw weak negative association (r=-0.26, n=51, p=0.0692, not distinguishable from zero at p<0.05). Triage names no single confounder column to partial on; read the raw coefficient with the card's stated caveats. Ecological correlation only: does not show the exposure causes or prevents Alzheimer's at the individual level."
    },
    {
      "id": "B4",
      "level": "state",
      "status": "analysed",
      "exposure": "pct_below_poverty",
      "outcome": "alz_prevalence_65plus_pct",
      "n": 51,
      "pearson": {
        "r": 0.3152795547069013,
        "p": 0.02422497193949701
      },
      "spearman": {
        "rho": 0.3481443311048223,
        "p": 0.012298119646069274
      },
      "partial": null,
      "divergence_flag": false,
      "sign_flip_vs_literature": false,
      "modelled_vs_measured": {
        "exposure": "measured/administrative -- U.S. Census Bureau, ACS 2023 1-Year Estimates, GCT1701",
        "outcome": "modelled/derived -- Alzheimer's Association 2025 Alzheimer's Disease Facts and Figures, Table 5 (data from Dhana et al., state/county prevalence model)"
      },
      "verdict": "Raw moderate positive association (r=0.32, n=51, p=0.0242). Triage names no single confounder column to partial on; read the raw coefficient with the card's stated caveats. Ecological correlation only: does not show the exposure causes or prevents Alzheimer's at the individual level."
    },
    {
      "id": "B5",
      "level": "state",
      "status": "analysed",
      "exposure": "primary_care_physicians_per_100k",
      "outcome": "alz_deaths_per_100k",
      "n": 51,
      "pearson": {
        "r": -0.37035264287194886,
        "p": 0.00746986987503023
      },
      "spearman": {
        "rho": -0.15945603540898626,
        "p": 0.2637025774400581
      },
      "partial": null,
      "divergence_flag": false,
      "sign_flip_vs_literature": false,
      "modelled_vs_measured": {
        "exposure": "measured/administrative -- America's Health Rankings, Primary Care Providers (CMS National Plan and Provider Enumeration System)",
        "outcome": "measured/administrative -- Alzheimer's Association 2025 Facts and Figures, Table 6 (NCHS)"
      },
      "verdict": "Raw moderate negative association (r=-0.37, n=51, p=0.00747). Triage names no single confounder column to partial on; read the raw coefficient with the card's stated caveats. Ecological correlation only: does not show the exposure causes or prevents Alzheimer's at the individual level."
    },
    {
      "id": "B6",
      "level": "state",
      "status": "analysed",
      "exposure": "nursing_home_beds_per_1000",
      "outcome": "alz_deaths_per_100k",
      "n": 51,
      "pearson": {
        "r": 0.0955678094247196,
        "p": 0.504708037238676
      },
      "spearman": {
        "rho": 0.09775524991908298,
        "p": 0.49495927346034607
      },
      "partial": null,
      "divergence_flag": false,
      "sign_flip_vs_literature": false,
      "modelled_vs_measured": {
        "exposure": "measured/administrative -- Becker's Hospital Review, States ranked by nursing home beds per capita (May 2026), using Census population + KFF CNF bed data",
        "outcome": "measured/administrative -- Alzheimer's Association 2025 Facts and Figures, Table 6 (NCHS)"
      },
      "verdict": "Raw negligible positive association (r=0.10, n=51, p=0.505, not distinguishable from zero at p<0.05). Triage names no single confounder column to partial on; read the raw coefficient with the card's stated caveats. Ecological correlation only: does not show the exposure causes or prevents Alzheimer's at the individual level."
    },
    {
      "id": "C1",
      "level": "county",
      "status": "analysed",
      "exposure": "pm25_avg_ugm3",
      "outcome": "norc_dementia_mortality_rate_2020",
      "n": 2997,
      "pearson": {
        "r": -0.12226592869377387,
        "p": 1.8697435825057825e-11
      },
      "spearman": {
        "rho": -0.09211664108674718,
        "p": 4.3823389902165856e-07
      },
      "partial": null,
      "divergence_flag": false,
      "sign_flip_vs_literature": false,
      "modelled_vs_measured": {
        "exposure": "modelled/derived -- County Health Rankings & Roadmaps (Univ. of Wisconsin Population Health Institute), 2024 release",
        "outcome": "modelled/derived -- Derived from NORC Dementia DataHub counts per the DataHub's own published rate formula (mortality and COVID measures are divided by prev_cnt, not bene_cnt, per the codebook)"
      },
      "verdict": "Raw weak negative association (r=-0.12, n=2997, p=1.87e-11). Triage names no single confounder column to partial on; read the raw coefficient with the card's stated caveats. Ecological correlation only: does not show the exposure causes or prevents Alzheimer's at the individual level."
    },
    {
      "id": "C2",
      "level": "county",
      "status": "analysed",
      "exposure": "social_association_index",
      "outcome": "norc_dementia_prevalence_rate_2020",
      "n": 3104,
      "pearson": {
        "r": 0.052087979408101295,
        "p": 0.0036983318802124967
      },
      "spearman": {
        "rho": 0.051974752332863125,
        "p": 0.003773632524036468
      },
      "partial": null,
      "divergence_flag": false,
      "sign_flip_vs_literature": false,
      "modelled_vs_measured": {
        "exposure": "measured/administrative -- County Health Rankings & Roadmaps (Univ. of Wisconsin Population Health Institute), 2024 release",
        "outcome": "modelled/derived -- Derived from NORC Dementia DataHub counts per the DataHub's own published rate formula (dementiadatahub.org/resources/outcome-measures.html)"
      },
      "verdict": "Raw negligible positive association (r=0.05, n=3104, p=0.0037). Triage names no single confounder column to partial on; read the raw coefficient with the card's stated caveats. Ecological correlation only: does not show the exposure causes or prevents Alzheimer's at the individual level."
    },
    {
      "id": "C3",
      "level": "county",
      "status": "analysed",
      "exposure": "pct_living_alone_65plus",
      "outcome": "norc_prev_cnt_2020",
      "n": 3096,
      "pearson": {
        "r": -0.06984564827780163,
        "p": 0.00010044577535958744
      },
      "spearman": {
        "rho": -0.09861181909237703,
        "p": 3.838630067170232e-08
      },
      "partial": {
        "controls": [
          "pct_65plus"
        ],
        "r": -0.06055205027688161,
        "p": 0.0007490878548031991,
        "n": 3096
      },
      "divergence_flag": false,
      "sign_flip_vs_literature": false,
      "modelled_vs_measured": {
        "exposure": "modelled/derived -- US Census Bureau, American Community Survey 5-Year Estimates 2020-2024 (detailed tables), retrieved via the Census Reporter API (a non-key-gated public proxy of the official Census Bureau ACS API)",
        "outcome": "modelled/derived -- NORC Dementia DataHub (NORC at the University of Chicago), 2020 Public Use File"
      },
      "verdict": "Raw negligible negative association (r=-0.07, n=3096, p=0.0001). Controlling for pct_65plus, the partial r is -0.06 (p=0.000749) and the association SURVIVES -- not explained away by pct_65plus alone, though this remains an ecological (group-level) association, not evidence of an individual-level effect. Ecological correlation only: does not show the exposure causes or prevents Alzheimer's at the individual level."
    },
    {
      "id": "C4",
      "level": "county",
      "status": "analysed",
      "exposure": "primary_care_physicians_per_100k",
      "outcome": "norc_dementia_mortality_rate_2020",
      "n": 2873,
      "pearson": {
        "r": -0.05893861699777965,
        "p": 0.0015749607976141213
      },
      "spearman": {
        "rho": -0.07541362137023865,
        "p": 5.2055354661699086e-05
      },
      "partial": null,
      "divergence_flag": false,
      "sign_flip_vs_literature": false,
      "modelled_vs_measured": {
        "exposure": "modelled/derived -- County Health Rankings & Roadmaps (Univ. of Wisconsin Population Health Institute), 2024 release",
        "outcome": "modelled/derived -- Derived from NORC Dementia DataHub counts per the DataHub's own published rate formula (mortality and COVID measures are divided by prev_cnt, not bene_cnt, per the codebook)"
      },
      "verdict": "Raw negligible negative association (r=-0.06, n=2873, p=0.00157). Triage names no single confounder column to partial on; read the raw coefficient with the card's stated caveats. Ecological correlation only: does not show the exposure causes or prevents Alzheimer's at the individual level."
    },
    {
      "id": "D1",
      "level": "county",
      "status": "analysed",
      "exposure": "pct_black",
      "outcome": "norc_dementia_prevalence_rate_2020",
      "n": 3096,
      "pearson": {
        "r": 0.30144477225731736,
        "p": 4.690566920534984e-66
      },
      "spearman": {
        "rho": 0.42685996502893725,
        "p": 2.415785961937888e-137
      },
      "partial": {
        "controls": [
          "median_household_income"
        ],
        "r": 0.26685092539837163,
        "p": 1.2514333087343013e-51,
        "n": 3096
      },
      "divergence_flag": false,
      "sign_flip_vs_literature": false,
      "modelled_vs_measured": {
        "exposure": "modelled/derived -- US Census Bureau, American Community Survey 5-Year Estimates 2020-2024 (detailed tables), retrieved via the Census Reporter API (a non-key-gated public proxy of the official Census Bureau ACS API)",
        "outcome": "modelled/derived -- Derived from NORC Dementia DataHub counts per the DataHub's own published rate formula (dementiadatahub.org/resources/outcome-measures.html)"
      },
      "verdict": "Raw moderate positive association (r=0.30, n=3096, p=4.69e-66). Controlling for median_household_income, the partial r is 0.27 (p=1.25e-51) and the association SURVIVES -- not explained away by median_household_income alone, though this remains an ecological (group-level) association, not evidence of an individual-level effect. Ecological correlation only: does not show the exposure causes or prevents Alzheimer's at the individual level."
    },
    {
      "id": "D2",
      "level": "county",
      "status": "analysed",
      "exposure": "pct_below_poverty",
      "outcome": "norc_dementia_mortality_rate_2020",
      "n": 2997,
      "pearson": {
        "r": 0.010904901122452331,
        "p": 0.550670287494417
      },
      "spearman": {
        "rho": 0.004217385515048812,
        "p": 0.8174819105869588
      },
      "partial": {
        "controls": [
          "pct_uninsured"
        ],
        "r": 0.010219051473935903,
        "p": 0.5760103618652501,
        "n": 2997
      },
      "divergence_flag": false,
      "sign_flip_vs_literature": false,
      "modelled_vs_measured": {
        "exposure": "modelled/derived -- US Census Bureau, American Community Survey 5-Year Estimates 2020-2024 (detailed tables), retrieved via the Census Reporter API (a non-key-gated public proxy of the official Census Bureau ACS API)",
        "outcome": "modelled/derived -- Derived from NORC Dementia DataHub counts per the DataHub's own published rate formula (mortality and COVID measures are divided by prev_cnt, not bene_cnt, per the codebook)"
      },
      "verdict": "Raw negligible positive association (r=0.01, n=2997, p=0.551, not distinguishable from zero at p<0.05). Because the raw association was not significant to begin with, the partial r=0.01 (p=0.576) controlling for pct_uninsured has no real baseline effect to explain away -- reported for completeness, not as a finding. Ecological correlation only: does not show the exposure causes or prevents Alzheimer's at the individual level."
    },
    {
      "id": "I1",
      "level": "country",
      "status": "analysed",
      "exposure": "gdp_per_capita_usd",
      "outcome": "dementia_deaths_per_100k_age_std",
      "n": 191,
      "pearson": {
        "r": 0.8175616326816912,
        "p": 3.521246230449554e-47
      },
      "spearman": {
        "rho": 0.6365816178761277,
        "p": 4.281198098715872e-23
      },
      "partial": null,
      "divergence_flag": false,
      "sign_flip_vs_literature": false,
      "modelled_vs_measured": {
        "exposure": "measured/administrative -- World Bank",
        "outcome": "modelled/derived -- WHO Global Health Estimates (GHE) 2021 update (sibling column dementia_deaths_total's caveat: GHE cause-of-death estimates are themselves modelled via WHO's cause-of-death ensemble models, not raw vital registration counts)"
      },
      "verdict": "Raw strong positive association (r=0.82, n=191, p=3.52e-47). Triage names no single confounder column to partial on; read the raw coefficient with the card's stated caveats. Ecological correlation only: does not show the exposure causes or prevents Alzheimer's at the individual level."
    },
    {
      "id": "I2",
      "level": "country",
      "status": "analysed",
      "exposure": "pct_diabetes",
      "outcome": "dementia_daly_per_100k",
      "n": 190,
      "pearson": {
        "r": -0.4317421996326922,
        "p": 4.990632103353555e-10
      },
      "spearman": {
        "rho": -0.30148932540776024,
        "p": 2.3672401102080663e-05
      },
      "partial": null,
      "divergence_flag": false,
      "sign_flip_vs_literature": true,
      "modelled_vs_measured": {
        "exposure": "modelled/derived -- WHO Global Health Observatory (NCD-RisC)",
        "outcome": "modelled/derived -- WHO Global Health Estimates (GHE) 2021 update, via Our World in Data indicator export"
      },
      "verdict": "Raw moderate negative association (r=-0.43, n=190, p=4.99e-10). Triage names no single confounder column to partial on; read the raw coefficient with the card's stated caveats. SIGN FLIP vs. established literature (diabetes is an established dementia risk factor) -- read this as a measurement/diagnostic-capacity finding about the data, not a discovery about risk. Ecological correlation only: does not show the exposure causes or prevents Alzheimer's at the individual level."
    },
    {
      "id": "I3",
      "level": "country",
      "status": "analysed",
      "exposure": "health_spend_per_capita_usd",
      "outcome": "dementia_daly_per_100k",
      "n": 191,
      "pearson": {
        "r": 0.7561780655089955,
        "p": 1.1828479789556273e-36
      },
      "spearman": {
        "rho": 0.7638330118489942,
        "p": 8.669054252629024e-38
      },
      "partial": {
        "controls": [
          "gdp_per_capita_usd"
        ],
        "r": 0.27610288101359637,
        "p": 0.00011054692808450486,
        "n": 191
      },
      "divergence_flag": false,
      "sign_flip_vs_literature": false,
      "modelled_vs_measured": {
        "exposure": "measured/administrative -- World Bank / WHO GHED",
        "outcome": "modelled/derived -- WHO Global Health Estimates (GHE) 2021 update, via Our World in Data indicator export"
      },
      "verdict": "Raw strong positive association (r=0.76, n=191, p=1.18e-36). Controlling for gdp_per_capita_usd, the partial r falls to 0.28 (p=0.000111) -- well under half the raw value, so the raw association largely COLLAPSES and is consistent with it measuring gdp_per_capita_usd rather than health_spend_per_capita_usd itself. Ecological correlation only: does not show the exposure causes or prevents Alzheimer's at the individual level."
    },
    {
      "id": "I4",
      "level": "country",
      "status": "analysed",
      "exposure": "dementia_plan_exists",
      "outcome": "dementia_daly_per_100k",
      "n": 51,
      "pearson": {
        "r": 0.6754991851320471,
        "p": 5.3912386954337963e-08
      },
      "spearman": {
        "rho": 0.6528499197759614,
        "p": 2.081559096697284e-07
      },
      "partial": {
        "controls": [
          "gdp_per_capita_usd"
        ],
        "r": 0.42138120956327396,
        "p": 0.0020738595467718938,
        "n": 51
      },
      "divergence_flag": false,
      "sign_flip_vs_literature": false,
      "modelled_vs_measured": {
        "exposure": "measured/administrative -- WHO Global Dementia Observatory (GDO)",
        "outcome": "modelled/derived -- WHO Global Health Estimates (GHE) 2021 update, via Our World in Data indicator export"
      },
      "verdict": "Raw strong positive association (r=0.68, n=51, p=5.39e-08). Controlling for gdp_per_capita_usd, the partial r is 0.42 (p=0.00207) and the association SURVIVES -- not explained away by gdp_per_capita_usd alone, though this remains an ecological (group-level) association, not evidence of an individual-level effect. Ecological correlation only: does not show the exposure causes or prevents Alzheimer's at the individual level."
    },
    {
      "id": "I5",
      "level": "country",
      "status": "analysed",
      "exposure": "pct_air_pollution_exposure",
      "outcome": "dementia_deaths_per_100k_age_std",
      "n": 186,
      "pearson": {
        "r": -0.6410918045698456,
        "p": 6.448092446633988e-23
      },
      "spearman": {
        "rho": -0.48975111062529786,
        "p": 1.3009675824254199e-12
      },
      "partial": {
        "controls": [
          "gdp_per_capita_usd"
        ],
        "r": -0.4036526665523013,
        "p": 1.2168274252021422e-08,
        "n": 185
      },
      "divergence_flag": false,
      "sign_flip_vs_literature": false,
      "modelled_vs_measured": {
        "exposure": "modelled/derived -- World Bank (based on satellite-derived PM2.5 modeling, Brauer et al./Global Burden of Disease-adjacent methodology but published directly by WB, not IHME)",
        "outcome": "modelled/derived -- WHO Global Health Estimates (GHE) 2021 update (sibling column dementia_deaths_total's caveat: GHE cause-of-death estimates are themselves modelled via WHO's cause-of-death ensemble models, not raw vital registration counts)"
      },
      "verdict": "Raw strong negative association (r=-0.64, n=186, p=6.45e-23). Controlling for gdp_per_capita_usd, the partial r is -0.40 (p=1.22e-08) and the association SURVIVES -- not explained away by gdp_per_capita_usd alone, though this remains an ecological (group-level) association, not evidence of an individual-level effect. Ecological correlation only: does not show the exposure causes or prevents Alzheimer's at the individual level."
    },
    {
      "id": "J1",
      "level": "country",
      "status": "analysed",
      "exposure": "gini",
      "outcome": "dementia_deaths_per_100k_age_std",
      "n": 169,
      "pearson": {
        "r": -0.33290602974633166,
        "p": 9.75798864506453e-06
      },
      "spearman": {
        "rho": -0.3613061830343156,
        "p": 1.391889501295029e-06
      },
      "partial": null,
      "divergence_flag": false,
      "sign_flip_vs_literature": false,
      "modelled_vs_measured": {
        "exposure": "measured/administrative -- World Bank (mostly PovcalNet/household survey based)",
        "outcome": "modelled/derived -- WHO Global Health Estimates (GHE) 2021 update (sibling column dementia_deaths_total's caveat: GHE cause-of-death estimates are themselves modelled via WHO's cause-of-death ensemble models, not raw vital registration counts)"
      },
      "verdict": "Raw moderate negative association (r=-0.33, n=169, p=9.76e-06). Triage names no single confounder column to partial on; read the raw coefficient with the card's stated caveats. Ecological correlation only: does not show the exposure causes or prevents Alzheimer's at the individual level."
    },
    {
      "id": "J2",
      "level": "country",
      "status": "analysed",
      "exposure": "physicians_per_1000",
      "outcome": "dementia_deaths_per_100k_age_std",
      "n": 192,
      "pearson": {
        "r": 0.6204026154904108,
        "p": 8.234909761904327e-22
      },
      "spearman": {
        "rho": 0.6527414191854329,
        "p": 1.0858130231951326e-24
      },
      "partial": null,
      "divergence_flag": false,
      "sign_flip_vs_literature": false,
      "modelled_vs_measured": {
        "exposure": "measured/administrative -- World Bank (WHO Global Health Workforce Statistics)",
        "outcome": "modelled/derived -- WHO Global Health Estimates (GHE) 2021 update (sibling column dementia_deaths_total's caveat: GHE cause-of-death estimates are themselves modelled via WHO's cause-of-death ensemble models, not raw vital registration counts)"
      },
      "verdict": "Raw strong positive association (r=0.62, n=192, p=8.23e-22). Triage names no single confounder column to partial on; read the raw coefficient with the card's stated caveats. Ecological correlation only: does not show the exposure causes or prevents Alzheimer's at the individual level."
    },
    {
      "id": "J3",
      "level": "country",
      "status": "analysed",
      "exposure": "pct_urban",
      "outcome": "dementia_daly_per_100k",
      "n": 192,
      "pearson": {
        "r": 0.46561674387084606,
        "p": 1.0094864750712309e-11
      },
      "spearman": {
        "rho": 0.47973306342993716,
        "p": 1.917075302750466e-12
      },
      "partial": null,
      "divergence_flag": false,
      "sign_flip_vs_literature": false,
      "modelled_vs_measured": {
        "exposure": "measured/administrative -- World Bank",
        "outcome": "modelled/derived -- WHO Global Health Estimates (GHE) 2021 update, via Our World in Data indicator export"
      },
      "verdict": "Raw moderate positive association (r=0.47, n=192, p=1.01e-11). Triage names no single confounder column to partial on; read the raw coefficient with the card's stated caveats. Ecological correlation only: does not show the exposure causes or prevents Alzheimer's at the individual level."
    },
    {
      "id": "J4",
      "level": "country",
      "status": "analysed",
      "exposure": "literacy_rate",
      "outcome": "dementia_deaths_per_100k_age_std",
      "n": 162,
      "pearson": {
        "r": 0.3673953136158875,
        "p": 1.5150546046158156e-06
      },
      "spearman": {
        "rho": 0.4707174133190517,
        "p": 2.599127933597236e-10
      },
      "partial": null,
      "divergence_flag": false,
      "sign_flip_vs_literature": false,
      "modelled_vs_measured": {
        "exposure": "measured/administrative -- World Bank (UNESCO Institute for Statistics)",
        "outcome": "modelled/derived -- WHO Global Health Estimates (GHE) 2021 update (sibling column dementia_deaths_total's caveat: GHE cause-of-death estimates are themselves modelled via WHO's cause-of-death ensemble models, not raw vital registration counts)"
      },
      "verdict": "Raw moderate positive association (r=0.37, n=162, p=1.52e-06). Triage names no single confounder column to partial on; read the raw coefficient with the card's stated caveats. Ecological correlation only: does not show the exposure causes or prevents Alzheimer's at the individual level."
    },
    {
      "id": "J5",
      "level": "country",
      "status": "analysed",
      "exposure": "measles_immunization_pct",
      "outcome": "dementia_deaths_per_100k_age_std",
      "n": 192,
      "pearson": {
        "r": 0.22089880309795362,
        "p": 0.002076947200279677
      },
      "spearman": {
        "rho": 0.32033698856477466,
        "p": 5.907472828784116e-06
      },
      "partial": null,
      "divergence_flag": false,
      "sign_flip_vs_literature": false,
      "modelled_vs_measured": {
        "exposure": "measured/administrative -- World Bank / WHO-UNICEF Estimates of National Immunization Coverage (WUENIC)",
        "outcome": "modelled/derived -- WHO Global Health Estimates (GHE) 2021 update (sibling column dementia_deaths_total's caveat: GHE cause-of-death estimates are themselves modelled via WHO's cause-of-death ensemble models, not raw vital registration counts)"
      },
      "verdict": "Raw weak positive association (r=0.22, n=192, p=0.00208). Triage names no single confounder column to partial on; read the raw coefficient with the card's stated caveats. Ecological correlation only: does not show the exposure causes or prevents Alzheimer's at the individual level."
    },
    {
      "id": "A1",
      "level": "state",
      "status": "analysed",
      "exposure": "scd_reported__overall",
      "outcome": "pct_depression",
      "n": 51,
      "pearson": {
        "r": 0.46498614111040243,
        "p": 0.0005864460764183104
      },
      "spearman": {
        "rho": 0.44021001357150485,
        "p": 0.0012267522320959666
      },
      "partial": null,
      "divergence_flag": false,
      "sign_flip_vs_literature": false,
      "modelled_vs_measured": {
        "exposure": "measured/administrative -- CDC Behavioral Risk Factor Surveillance System (BRFSS), Alzheimer's Disease and Healthy Aging Data",
        "outcome": "measured/administrative -- America's Health Rankings, Depression (CDC BRFSS)"
      },
      "verdict": "Raw moderate positive association (r=0.46, n=51, p=0.000586). Triage names no single confounder column to partial on; read the raw coefficient with the card's stated caveats. Ecological correlation only: does not show the exposure causes or prevents Alzheimer's at the individual level."
    },
    {
      "id": "A2",
      "level": "state",
      "status": "analysed",
      "exposure": "care_for_dementia__overall",
      "outcome": "nursing_home_beds_per_1000",
      "n": 51,
      "pearson": {
        "r": -0.17649375310084123,
        "p": 0.21537386860437802
      },
      "spearman": {
        "rho": -0.26480040073926303,
        "p": 0.060402237660881306
      },
      "partial": null,
      "divergence_flag": false,
      "sign_flip_vs_literature": false,
      "modelled_vs_measured": {
        "exposure": "measured/administrative -- CDC Behavioral Risk Factor Surveillance System (BRFSS), Alzheimer's Disease and Healthy Aging Data",
        "outcome": "measured/administrative -- Becker's Hospital Review, States ranked by nursing home beds per capita (May 2026), using Census population + KFF CNF bed data"
      },
      "verdict": "Raw weak negative association (r=-0.18, n=51, p=0.215, not distinguishable from zero at p<0.05). Triage names no single confounder column to partial on; read the raw coefficient with the card's stated caveats. Ecological correlation only: does not show the exposure causes or prevents Alzheimer's at the individual level."
    },
    {
      "id": "A3",
      "level": "state",
      "status": "analysed",
      "exposure": "scd_reported__65_years_or_older",
      "outcome": "alz_prevalence_65plus_pct",
      "n": 51,
      "pearson": {
        "r": -0.26069427457699956,
        "p": 0.06465050472315577
      },
      "spearman": {
        "rho": -0.21663012432223291,
        "p": 0.1267881858791613
      },
      "partial": null,
      "divergence_flag": false,
      "sign_flip_vs_literature": false,
      "modelled_vs_measured": {
        "exposure": "measured/administrative -- CDC Behavioral Risk Factor Surveillance System (BRFSS), Alzheimer's Disease and Healthy Aging Data",
        "outcome": "modelled/derived -- Alzheimer's Association 2025 Alzheimer's Disease Facts and Figures, Table 5 (data from Dhana et al., state/county prevalence model)"
      },
      "verdict": "Raw weak negative association (r=-0.26, n=51, p=0.0647, not distinguishable from zero at p<0.05). Triage names no single confounder column to partial on; read the raw coefficient with the card's stated caveats. Ecological correlation only: does not show the exposure causes or prevents Alzheimer's at the individual level."
    },
    {
      "id": "A4",
      "level": "state",
      "status": "analysed",
      "exposure": "care_20h_plus_week__overall",
      "outcome": "unpaid_caregiver_hours_millions",
      "n": 51,
      "pearson": {
        "r": 0.2968402850474028,
        "p": 0.03440920684478623
      },
      "spearman": {
        "rho": 0.43129046989492653,
        "p": 0.001579036735378262
      },
      "partial": null,
      "divergence_flag": false,
      "sign_flip_vs_literature": false,
      "modelled_vs_measured": {
        "exposure": "measured/administrative -- CDC Behavioral Risk Factor Surveillance System (BRFSS), Alzheimer's Disease and Healthy Aging Data",
        "outcome": "measured/administrative -- Alzheimer's Association 2025 Facts and Figures, Table 10"
      },
      "verdict": "Raw weak positive association (r=0.30, n=51, p=0.0344). Triage names no single confounder column to partial on; read the raw coefficient with the card's stated caveats. Ecological correlation only: does not show the exposure causes or prevents Alzheimer's at the individual level."
    },
    {
      "id": "A5",
      "level": "state",
      "status": "analysed",
      "exposure": "scd_reported__overall",
      "outcome": "pct_hearing_loss",
      "n": 51,
      "pearson": {
        "r": 0.033473500103684904,
        "p": 0.8156157346613292
      },
      "spearman": {
        "rho": -0.03249530448208162,
        "p": 0.8209140477606088
      },
      "partial": null,
      "divergence_flag": false,
      "sign_flip_vs_literature": false,
      "modelled_vs_measured": {
        "exposure": "measured/administrative -- CDC Behavioral Risk Factor Surveillance System (BRFSS), Alzheimer's Disease and Healthy Aging Data",
        "outcome": "measured/administrative -- CDC/NCHS, Any Hearing Loss by State, National Health Interview Survey 2014-2016 (Blackwell & Norris)"
      },
      "verdict": "Raw negligible positive association (r=0.03, n=51, p=0.816, not distinguishable from zero at p<0.05). Triage names no single confounder column to partial on; read the raw coefficient with the card's stated caveats. Ecological correlation only: does not show the exposure causes or prevents Alzheimer's at the individual level."
    },
    {
      "id": "A6",
      "level": "state",
      "status": "analysed",
      "exposure": "care_provided__overall",
      "outcome": "medicaid_ltss_spend_per_capita",
      "n": 51,
      "pearson": {
        "r": -0.008607109636971571,
        "p": 0.9522000074592002
      },
      "spearman": {
        "rho": -0.0180123102154903,
        "p": 0.9001635449574587
      },
      "partial": null,
      "divergence_flag": false,
      "sign_flip_vs_literature": false,
      "modelled_vs_measured": {
        "exposure": "measured/administrative -- CDC Behavioral Risk Factor Surveillance System (BRFSS), Alzheimer's Disease and Healthy Aging Data",
        "outcome": "modelled/derived -- Derived by this project: medicaid_dementia_spend_total_usd / pop_total"
      },
      "verdict": "Raw negligible negative association (r=-0.01, n=51, p=0.952, not distinguishable from zero at p<0.05). Triage names no single confounder column to partial on; read the raw coefficient with the card's stated caveats. Ecological correlation only: does not show the exposure causes or prevents Alzheimer's at the individual level."
    },
    {
      "id": "A7",
      "level": "state",
      "status": "analysed",
      "exposure": "scd_with_consequence__65_years_or_older",
      "outcome": "alz_deaths_per_100k",
      "n": 51,
      "pearson": {
        "r": -0.08501486258938974,
        "p": 0.5530796988780158
      },
      "spearman": {
        "rho": -0.01101984479718751,
        "p": 0.9388234527994007
      },
      "partial": null,
      "divergence_flag": false,
      "sign_flip_vs_literature": false,
      "modelled_vs_measured": {
        "exposure": "measured/administrative -- CDC Behavioral Risk Factor Surveillance System (BRFSS), Alzheimer's Disease and Healthy Aging Data",
        "outcome": "measured/administrative -- Alzheimer's Association 2025 Facts and Figures, Table 6 (NCHS)"
      },
      "verdict": "Raw negligible negative association (r=-0.09, n=51, p=0.553, not distinguishable from zero at p<0.05). Triage names no single confounder column to partial on; read the raw coefficient with the card's stated caveats. Ecological correlation only: does not show the exposure causes or prevents Alzheimer's at the individual level."
    },
    {
      "id": "A8",
      "level": "state",
      "status": "analysed",
      "exposure": "care_for_dementia__65_years_or_older",
      "outcome": "geriatricians_count",
      "n": 51,
      "pearson": {
        "r": 0.1765566507824201,
        "p": 0.21520776905364092
      },
      "spearman": {
        "rho": 0.232163464861555,
        "p": 0.10113812606087424
      },
      "partial": null,
      "divergence_flag": false,
      "sign_flip_vs_literature": false,
      "modelled_vs_measured": {
        "exposure": "measured/administrative -- CDC Behavioral Risk Factor Surveillance System (BRFSS), Alzheimer's Disease and Healthy Aging Data",
        "outcome": "measured/administrative -- Alzheimer's Association 2025 Facts and Figures, Table 14, citing American Geriatrics Society"
      },
      "verdict": "Raw weak positive association (r=0.18, n=51, p=0.215, not distinguishable from zero at p<0.05). Triage names no single confounder column to partial on; read the raw coefficient with the card's stated caveats. Ecological correlation only: does not show the exposure causes or prevents Alzheimer's at the individual level."
    },
    {
      "id": "A9",
      "level": "state",
      "status": "analysed",
      "exposure": "care_expected__65_years_or_older",
      "outcome": "unpaid_caregiver_value_usd",
      "n": 51,
      "pearson": {
        "r": 0.16484210220216222,
        "p": 0.2477006742303427
      },
      "spearman": {
        "rho": 0.09368563968338282,
        "p": 0.5131741065726492
      },
      "partial": null,
      "divergence_flag": false,
      "sign_flip_vs_literature": false,
      "modelled_vs_measured": {
        "exposure": "measured/administrative -- CDC Behavioral Risk Factor Surveillance System (BRFSS), Alzheimer's Disease and Healthy Aging Data",
        "outcome": "measured/administrative -- Alzheimer's Association 2025 Facts and Figures, Table 10"
      },
      "verdict": "Raw weak positive association (r=0.16, n=51, p=0.248, not distinguishable from zero at p<0.05). Triage names no single confounder column to partial on; read the raw coefficient with the card's stated caveats. Ecological correlation only: does not show the exposure causes or prevents Alzheimer's at the individual level."
    }
  ]
}