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Rural-Urban Differences in Alzheimer's Disease and Related Disorders Diagnostic Prevalence in Kentucky and West Virginia
Abner Erin L, Jicha Gregory A, Christian W Jay, Schreurs Bernard G. The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, 2015-10-31
Topic: Amyloid, tau and blood-test diagnosis
Older adults living in rural areas may face barriers to obtaining a diagnosis of Alzheimer's disease and related disorders (ADRD). We sought to examine rural-urban differences in prevalence of ADRD among Medicare beneficiaries in Kentucky and West Virginia, 2 contiguous, geographically similar states with large rural areas and aged populations. We used Centers for Medicare and Medicaid Services Public Use Files data from 2007 to 2013 to assess prevalence of ADRD at the county level among all Medicare beneficiaries in each state. Rural-Urban Continuum Codes were used to classify counties as rural or urban. We used Poisson regression to estimate unadjusted and adjusted prevalence ratios. Primary analyses focused on 2013 data and were repeated for 2007 to 2012. This study was completely ecologic. After adjusting for state, average beneficiary age, percent of female beneficiaries, percent of beneficiaries eligible for Medicaid in each county, Central Appalachian county, percent of age-eligible residents enrolled in Medicare, and percent of residents under age 65 enrolled in Medicare in our adjusted models, we found that 2013 ADRD diagnostic prevalence was 11% lower in rural counties (95% CI: 9%-13%). Medicare beneficiaries in rural counties in Kentucky and West Virginia may be underdiagnosed with respect to ADRD. However, due to the ecologic design, and evidence of a younger, more heavily male beneficiary population in some rural areas, further studies using individual-level data are needed to confirm the results.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Abner Erin, L., Jicha Gregory, A., Jay, C. W., & Schreurs Bernard, G. (2016). Rural-Urban Differences in Alzheimer's Disease and Related Disorders Diagnostic Prevalence in Kentucky and West Virginia. The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association. https://doi.org/10.1111/jrh.12155
Vancouver
Abner Erin L, Jicha Gregory A, Jay CW, Schreurs Bernard G. Rural-Urban Differences in Alzheimer's Disease and Related Disorders Diagnostic Prevalence in Kentucky and West Virginia. The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association. 2016. doi:10.1111/jrh.12155. PMID: 26515331.
BibTeX
@article{abnererin2016-26515331,
author = {Abner Erin, L. and Jicha Gregory, A. and Jay, Christian W and Schreurs Bernard, G.},
title = {{Rural-Urban Differences in Alzheimer's Disease and Related Disorders Diagnostic Prevalence in Kentucky and West Virginia}},
journal = {The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association},
year = {2016},
doi = {10.1111/jrh.12155},
pmid = {26515331},
url = {https://doi.org/10.1111/jrh.12155}
}
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Key findings
- After adjusting for state, average beneficiary age, percent of female beneficiaries, percent of beneficiaries eligible for Medicaid in each county, Central Appalachian county, percent of age-eligible residents enrolled in Medicare, and percent of residents under age 65 enrolled in Medicare in our adjusted models, we found that 2013 ADRD diagnostic prevalence was 11% lower in rural counties (95% CI: 9%-13%).
- However, due to the ecologic design, and evidence of a younger, more heavily male beneficiary population in some rural areas, further studies using individual-level data are needed to confirm the results.
Why it matters
Using Medicare data on every beneficiary in Kentucky and West Virginia, this county-level study found that diagnosed Alzheimer's and related disorders were 11% less common in rural counties than urban ones in 2013 (95% CI: 9%–13%), after adjusting for age, sex, Medicaid eligibility and Appalachian location. The authors say this suggests rural older adults "may be underdiagnosed." It does not show that they have less dementia. Because the data are county averages, and some rural areas had younger, more male beneficiaries, the authors say individual-level studies are needed to confirm it.
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Study details
- Evidence strengthLow
How this study scored 39/100
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 (The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association) |
| Journal's citation record | 1 / 4 | The Journal of Rural Health: journal h-index 94 (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 | 1 / 5 | 2016 — within 20 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 | 4 / 7 | Cited 75 times (OpenAlex, 2026-10-10) |
| Citations per year | 2 / 5 | 6.2 citations a year over 12 year(s) since 2016 |
| Impact for its field and year | 2 / 6 | Cited 1.2× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 3 / 6 | Cited by 19 other studies in this library |
| Still being cited | 2 / 4 | Cited 28 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Bernard G. Schreurs: h-index 34 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | University of Kentucky: institution h-index 824 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 3 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 26515331) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 39 / 100 | — |
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