Home › Research › Risk factors
Rural and Urban Differences in Dementia Diagnosis in the Western U.S
Lauren Cater, Andrew Nute, Kara M. Bensley, Maja Pederson, Brianna Beck, Jessica Fleser, Curtis W. Noonan, Rachel L. Peterson. Innovation in Aging, 2025-12-01
Topic: Risk, prevention and care in population studies
Plain-language summary
Abstract Prior research suggests diagnostic prevalence of Alzheimer’s disease and related dementias (ADRD) is lower in rural U.S., though noted geographic variations have been observed in studies of the southern and Midwest regions. We compared rural and urban diagnosed prevalence of ADRD and cognitive impairment in eight Western states: Alaska, California, Idaho, Montana, New Mexico, Oregon, Texas, Washington. Diagnostic codes for ADRD and cognitive impairment from Providence Health system’s electronic medical records were pulled from Jan. 1, 2018-June 30, 2025 for all active patients. Of 6,911,104 patients (min=Idaho: 45,160; max=California: 2.46 million), we observed a substantial difference in overall diagnosed prevalence across states of residence: Oregon and Montana had the highest diagnosed prevalence (6.6% and 6.5%, respectively); New Mexico had the lowest (2.3%). Overall diagnosed prevalence among those residing in urban and high commuting areas (RUCA 1-3, 4.1, 5.1, 8.1, 10.1) was 5.4% versus 4.7% among those residing in rural and low commuting areas (p < 0.001). Within-state urban versus rural differences in diagnosed prevalence was estimated for Alaska (4.8% vs. 3.5%; p < 0.001), California (4.8% vs. 4.2%; p < 0.001), Montana (7.3% urban vs. 5.1% rural; p < 0.001), New Mexico (3.2% vs. 2.2%; p = 0.01), Oregon (6.7% vs. 5.9%; p < 0.001), Texas (3.9% vs. 3.3%; p < 0.001) and Washington (6.3% vs. 5.3%; p < 0.001), but not for Idaho (3.5% vs. 3.4%; p = 0.57). Our findings within a single health system indicate lower ADRD diagnosed prevalence among patients residing in rural areas in 7 of the 8 states examined, suggesting a pattern of lower health system access and diagnosis.
What this study adds
Evidence grade: Low
Across eight Western U.S. states, diagnosed prevalence of Alzheimer's disease and related dementias was lower in rural and low-commuting areas than in urban and high-commuting areas. Reported effect size: 6.6%; 6.5%; 2.3%.
Taken from this record’s own fields, not from reading the paper. The grade is assigned from the abstract’s wording; what that means.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Cater, L., Nute, A., Bensley, K. M., Pederson, M., Beck, B., Fleser, J., et al. (2025). Rural and Urban Differences in Dementia Diagnosis in the Western U.S. Innovation in Aging. https://doi.org/10.1093/geroni/igaf122.4256
Vancouver
Cater L, Nute A, Bensley KM, Pederson M, Beck B, Fleser J, et al. Rural and Urban Differences in Dementia Diagnosis in the Western U.S. Innovation in Aging. 2025. doi:10.1093/geroni/igaf122.4256.
BibTeX
@article{cater2025-25d0fd78,
author = {Cater, Lauren and Nute, Andrew and Bensley, Kara M. and Pederson, Maja and Beck, Brianna and Fleser, Jessica and Noonan, Curtis W. and Peterson, Rachel L.},
title = {{Rural and Urban Differences in Dementia Diagnosis in the Western U.S}},
journal = {Innovation in Aging},
year = {2025},
doi = {10.1093/geroni/igaf122.4256},
url = {https://doi.org/10.1093/geroni/igaf122.4256}
}
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record names 8 authors; APA and Vancouver show the first six, BibTeX and the downloads carry all of them. Check the citation against the original before you use it.
Key findings
- Of 6,911,104 patients (min=Idaho: 45,160; max=California: 2.46 million), we observed a substantial difference in overall diagnosed prevalence across states of residence: Oregon and Montana had the highest diagnosed prevalence (6.6% and 6.5%, respectively); New Mexico had the lowest (2.3%).
- Overall diagnosed prevalence among those residing in urban and high commuting areas (RUCA 1-3, 4.1, 5.1, 8.1, 10.1) was 5.4% versus 4.7% among those residing in rural and low commuting areas (p < 0.001).
- Within-state urban versus rural differences in diagnosed prevalence was estimated for Alaska (4.8% vs. 3.5%; p < 0.001), California (4.8% vs. 4.2%; p < 0.001), Montana (7.3% urban vs. 5.1% rural; p < 0.001), New Mexico (3.2% vs. 2.2%; p = 0.01), Oregon (6.7% vs. 5.9%; p < 0.001), Texas (3.9% vs. 3.3%; p < 0.001) and Washington (6.3% vs. 5.3%; p < 0.001), but not for Idaho (3.5% vs. 3.4%; p = 0.57).
- Our findings within a single health system indicate lower ADRD diagnosed prevalence among patients residing in rural areas in 7 of the 8 states examined, suggesting a pattern of lower health system access and diagnosis.
Why it matters
Across eight Western U.S. states, diagnosed prevalence of Alzheimer's disease and related dementias was lower in rural and low-commuting areas than in urban and high-commuting areas. Diagnosed prevalence also varied substantially by state, from 6.6% in Oregon to 2.3% in New Mexico.
New to this subject? Start with our plain-English guide: Risk factors, ranked →
Study details
- Effect size6.6%; 6.5%; 2.3%
- Evidence strengthLow
How this study scored 30/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, studied in people and randomized / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Innovation in Aging) |
| Journal's citation record | 0 / 4 | Innovation in Aging: journal h-index 48 (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 | 4 / 5 | 2025 — within 3 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 | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| 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 3 year(s) since 2025 |
| 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 Rachel L. Peterson: h-index 20 (OpenAlex, whole career) |
| Institution's track record | 0 / 3 | University of Montana: institution h-index 485 (OpenAlex) |
| Multicenter collaboration | 1 / 3 | OpenAlex lists 2 institution(s) in 1 country |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 2 / 2 | Free to read |
| Total | 30 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Related
Studies in the library that share something with this one. The line above each title says what.
Related studies in Risk factors from nearby years
Also tagged “prevalence”
1,223 studies in the library carry the topic tag “prevalence”; these are this study's neighbours in a fixed, alphabetical-by-hash tour of them, not the closest in content. All 1,223 tagged studies.