Does the Area Deprivation Index (ADI) influence dementia evaluation and diagnosis in Virginia? (S29.004)

Topic: Risk, prevention and care in population studies

14,292 patients were diagnosed with dementia over 2018–2021 (age 76.5+/−10.3 years; 53.1% female), with 96.3% linked to a census-tract-level ADI. Only 6.4% of patients had an adequate evaluation (15.5% adequate labs, 21.9% adequate imaging) and 30.1% received a disease-specific diagnosis. Men had lower odds of receiving a disease-specific diagnosis (OR = 0.72; p<0.001), adjusted for all other factors. Patients were increasingly likely to receive disease-specific diagnoses from ages 50 – 90, with decreasing likelihood after age 90. Higher ADI (greater deprivation) increased the likelihood of undergoing adequate evaluation (tertile 2vs1 OR: 1.21, p=0.053; tertile 3vs1 OR: 1.29, p=0.036) but decreased the likelihood of receiving a disease-specific diagnosis (tertile 2vs1 OR: 0.89, p=0.043; tertile 3vs1 OR: 0.97, p=0.616). ADI had an opposite effect on evaluation and disease-specific diagnoses. Those in more disadvantaged neighborhoods were more likely to receive an adequate evaluation, but less likely to receive a disease-specific diagnosis. This finding may explain the lower rates of recruitment of historically marginalized populations into clinical trials. Disclosure: The institution of Dr. D’Abreu has received research support from Alzheimer’s and Related Diseases Research Award Fund (Virginia Center on Aging in the College of Health Professions). The institution of Dr. Chernyavskiy has received research support from Institute of Education Sciences. The institution of an immediate family member of Dr. Chernyavskiy has received research support from Institute of Education Sciences. The institution of Dr. Chernyavskiy has received research support from Commonwealth of Virginia ARDRAF.

Key findings

• 14,292 patients were diagnosed with dementia over 2018–2021 (age 76.5+/−10.3 years; 53.1% female), with 96.3% linked to a census-tract-level ADI.
• Only 6.4% of patients had an adequate evaluation (15.5% adequate labs, 21.9% adequate imaging) and 30.1% received a disease-specific diagnosis.
• Men had lower odds of receiving a disease-specific diagnosis (OR = 0.72; p<0.001), adjusted for all other factors.
• Patients were increasingly likely to receive disease-specific diagnoses from ages 50 – 90, with decreasing likelihood after age 90.
• Higher ADI (greater deprivation) increased the likelihood of undergoing adequate evaluation (tertile 2vs1 OR: 1.21, p=0.053; tertile 3vs1 OR: 1.29, p=0.036) but decreased the likelihood of receiving a disease-specific diagnosis (tertile 2vs1 OR: 0.89, p=0.043; tertile 3vs1 OR: 0.97, p=0.616).

Why it matters

In this group of dementia patients, only 6.4% received an adequate evaluation and 30.1% received a disease-specific diagnosis. People in more disadvantaged neighborhoods were more likely to get an adequate evaluation but less likely to receive a disease-specific diagnosis.

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Study details

• Participants4,600
• Effect size53.1%; 96.3%; 6.4%
• Evidence strengthLow

Read the original

• DOI: 10.1212/wnl.0000000000202532
• Original source →

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@article{dabreu2023-8f88e7a1,
  author  = {D’Abreu, Anelyssa and Chernyavskiy, Pavel},
  title   = {{Does the Area Deprivation Index (ADI) influence dementia evaluation and diagnosis in Virginia? (S29.004)}},
  journal = {Neurology},
  year    = {2023},
  doi     = {10.1212/wnl.0000000000202532},
  url     = {https://doi.org/10.1212/wnl.0000000000202532}
}

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