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Neighborhood Deprivation and Mortality Risk among Medicare Beneficiaries with Alzheimer’s Disease and Related Dementia
Joshua L. Paley, Inmaculada Hernandez, Joshua David Brown, Yonghui Wu, Jiang Bian, Stephen A. Anton, Jingchuan Serena Guo. Alzheimer s & Dementia, 2022-12-01
Topic: Risk, prevention and care in population studies
Abstract Background Alzheimer’s Disease (AD) and Related Dementias (ADRD) is a class of progressive fatal degenerative diseases that presents multiple causations and outcomes related to its biological, medical, and social determinants of health (SDoH). Studies have extensively explored biological and medical factors, however, SDoH, which is known to contribute to structural inequities in health outcomes, is understudied. We aimed to study the association between neighborhood deprivation (an important SDoH measurement of socioeconomic disadvantage), and the risk of mortality among older adults diagnosed with AD/ADRD. Method Using a 5% random sample of national Medicare claims data, we identified individuals newly diagnosed with ADRD in 2006‐2013. The outcome of interest was all‐cause mortality. The exposure of interest was area deprivation index (ADI), a validated neighborhood deprivation measure that incorporates factors of poverty, education, housing, and employment. ADI was spatiotemporally linked to the study cohort using 9‐digit ZIP codes and index scores were classified into 6 categories: quartiles plus the 10th and 90th percentile. We applied generalized estimation equations to model an odds ratio (OR) of mortality across the ADI categories while adjusting for demographic and clinical factors. Subgroup analyses were modeled within urban and rural areas, respectively. Results We included 74,462 patients with ADRD diagnosis, with a mean age of 82 (SD: 8.2) years; 72.3% were women and 65.8% (n = 31218) died over a median follow‐up of 3.5 years. A dose‐gradient association between the ADI and all‐cause mortality was observed in the ADRD population, with the risk of mortality gradually increasing with greater deprivation (Table). The dose‐gradient association between ADI and mortality remained after stratifying by urban and rural areas. ADRD patients in rural areas had a higher mortality risk than those in urban areas (Table). Conclusion Our findings suggest neighborhood deprivation is an important risk factor of mortality among older adults with ADRD while accounting for individuals’ demographic and clinical characteristics. The current results underscore the need for the design and implementation of intervention and policy programs to address structural disparities in outcomes of ADRD patients.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Paley, J. L., Hernandez, I., Brown, J. D., Wu, Y., Bian, J., Anton, S. A., et al. (2022). Neighborhood Deprivation and Mortality Risk among Medicare Beneficiaries with Alzheimer’s Disease and Related Dementia. Alzheimer s & Dementia. https://doi.org/10.1002/alz.066304
Vancouver
Paley JL, Hernandez I, Brown JD, Wu Y, Bian J, Anton SA, et al. Neighborhood Deprivation and Mortality Risk among Medicare Beneficiaries with Alzheimer’s Disease and Related Dementia. Alzheimer s & Dementia. 2022. doi:10.1002/alz.066304.
BibTeX
@article{paley2022-899e7e33,
author = {Paley, Joshua L. and Hernandez, Inmaculada and Brown, Joshua David and Wu, Yonghui and Bian, Jiang and Anton, Stephen A. and Guo, Jingchuan Serena},
title = {{Neighborhood Deprivation and Mortality Risk among Medicare Beneficiaries with Alzheimer’s Disease and Related Dementia}},
journal = {Alzheimer s \& Dementia},
year = {2022},
doi = {10.1002/alz.066304},
url = {https://doi.org/10.1002/alz.066304}
}
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Key findings
- Results We included 74,462 patients with ADRD diagnosis, with a mean age of 82 (SD: 8.2) years; 72.3% were women and 65.8% (n = 31218) died over a median follow‐up of 3.5 years.
- Conclusion Our findings suggest neighborhood deprivation is an important risk factor of mortality among older adults with ADRD while accounting for individuals’ demographic and clinical characteristics.
- The current results underscore the need for the design and implementation of intervention and policy programs to address structural disparities in outcomes of ADRD patients.
Why it matters
This study found that neighborhood deprivation was associated with higher mortality risk among older adults diagnosed with Alzheimer's disease and related dementias. The authors call for intervention and policy programs to address these social factors, but the work does not test any treatment, cure, or prevention for the disease.
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Study details
- Participants31,218
- Effect size72.3%; 65.8%
- Evidence strengthModerate
How this study scored 40/100
Published in a peer-reviewed journal. Scored zero for study design and randomized / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Alzheimer s & Dementia) |
| Journal's citation record | 2 / 4 | Alzheimer s & Dementia: journal h-index 228 (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 | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 3 / 5 | 2022 — within 6 year(s) of the newest study here |
| Sample size | 4 / 4 | 31,218 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomized / blinded | 0 / 2 | No randomization or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 0 / 7 | Cited 0 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.0 citations a year over 6 year(s) since 2022 |
| Impact for its field and year | 0 / 6 | Cited 0.0× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 0 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Jingchuan Serena Guo: h-index 22 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | University of California San Diego: institution h-index 1,852 (OpenAlex) |
| Multicenter collaboration | 1 / 3 | OpenAlex lists 3 institution(s) in 1 country |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 40 / 100 | — |
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