Home › Research › Risk factors
Alzheimer's Disease and Related Disorders Prevalence Differs by Appalachian Residence in Ohio
Wing Jeffrey J, Levine Deborah A, Ramamurthy Arun, Reider Carson. Journal of Alzheimer's disease : JAD, 2020-07-01
Topic: Amyloid, tau and blood-test diagnosis
Areas within the Appalachian region may have a greater burden of under diagnosed Alzheimer's disease and related disorders (ADRD). To estimate the prevalence of ADRD in the Appalachian counties of Ohio, and to determine if differences exist by geographic location (Appalachian/non-Appalachian and rural/urban) and across time among Medicare beneficiaries. Centers for Medicare and Medicaid Services Public Use Files from 2007-2017 were used to estimate county-level ADRD prevalence among all fee-for-service beneficiaries in Ohio. Negative binomial regression was used to estimate prevalence overall, by Appalachian Regional Commission's Appalachian/non-Appalachian designation, and by rural/urban (Rural-Urban Continuum Codes) classification. Models were repeated, adjusting for county-level demographics and comorbidities. The prevalence of ADRD varied by both Appalachian residence and rural status (p = 0.008). Before adjustment by county-level demographics and comorbidities, the prevalence of ADRD in urban Appalachian counties was 1-3% lower than in urban non-Appalachian counties, while rural Appalachian counties had 2-3% higher prevalence compared to rural non-Appalachian counties. After adjustment, the differences between prevalence ratios were accentuated; the prevalence ratio was consistently higher for rural Appalachian counties, yet varied across the study period for urban counties (1.03 in 2007 to 0.97 in 2017). The results suggest a disparate burden of ADRD in Ohio with higher prevalence in rural Appalachian counties. This potential difference by Appalachian region is important to consider for availability of services and subsequent delivery of care. In order to better understand the disparity, further epidemiologic studies are necessary to better estimate the burden of ADRD.
Key findings
- Negative binomial regression was used to estimate prevalence overall, by Appalachian Regional Commission's Appalachian/non-Appalachian designation, and by rural/urban (Rural-Urban Continuum Codes) classification.
- Before adjustment by county-level demographics and comorbidities, the prevalence of ADRD in urban Appalachian counties was 1-3% lower than in urban non-Appalachian counties, while rural Appalachian counties had 2-3% higher prevalence compared to rural non-Appalachian counties.
- The results suggest a disparate burden of ADRD in Ohio with higher prevalence in rural Appalachian counties.
Why it matters
This study found that Alzheimer's and related disorders prevalence among Medicare beneficiaries in Ohio differed by Appalachian residence and rural status, with rural Appalachian counties showing higher prevalence after adjustment. It describes geographic patterns of prevalence, not treatment or prevention.
New to this subject? Start with our plain-English guide: Risk factors, ranked →
Study details
- Evidence strengthLow
How this study scored 35/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of Alzheimer's disease : JAD) |
| Journal's citation record | 2 / 4 | Journal of Alzheimer s Disease: journal h-index 218 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 2 / 5 | 2020 — within 10 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 2 / 7 | Cited 14 times (OpenAlex, 2026-10-10) |
| Citations per year | 1 / 5 | 1.8 citations a year over 8 year(s) since 2020 |
| Impact for its field and year | 1 / 6 | Cited 0.6× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 2 / 6 | Cited by 7 other studies in this library |
| Still being cited | 1 / 4 | Cited 10 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 1 / 4 | Last-listed author Carson R. Reider: h-index 12 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | University of Michigan: institution h-index 2,240 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 2 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 32597814) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 35 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
May need a subscription OpenAlex found no free copy of the full text (checked 6 Feb 1020), so the publisher may charge for it. The PubMed abstract is free.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Wing Jeffrey, J., Levine Deborah, A., Arun, R., & Carson, R. (2020). Alzheimer's Disease and Related Disorders Prevalence Differs by Appalachian Residence in Ohio. Journal of Alzheimer's disease : JAD. https://doi.org/10.3233/JAD-200491
Vancouver
Wing Jeffrey J, Levine Deborah A, Arun R, Carson R. Alzheimer's Disease and Related Disorders Prevalence Differs by Appalachian Residence in Ohio. Journal of Alzheimer's disease : JAD. 2020. doi:10.3233/JAD-200491. PMID: 32597814.
BibTeX
@article{wingjeffrey2020-32597814,
author = {Wing Jeffrey, J. and Levine Deborah, A. and Arun, Ramamurthy and Carson, Reider},
title = {{Alzheimer's Disease and Related Disorders Prevalence Differs by Appalachian Residence in Ohio}},
journal = {Journal of Alzheimer's disease : JAD},
year = {2020},
doi = {10.3233/JAD-200491},
pmid = {32597814},
url = {https://doi.org/10.3233/JAD-200491}
}
Studies this one cites
Referenced by this study and also in the alzhub library, so you can read them here.
Later studies that cite this one
7 studies in the alzhub library list this one in their references.
Related studies in Risk factors
Also in Risk factors
356 studies in the library are filed under Risk factors with no topic tag they share with another; these are this study's neighbours in a fixed tour of them. The Risk factors hub.