Background:Areas within the Appalachian region may have a greater burden of under diagnosed Alzheimer’s disease and related disorders (ADRD). Objective: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. Methods: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. Results: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). Conclusion: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.

中文翻译：

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俄亥俄阿巴拉契亚人居住区的阿尔茨海默氏病和相关疾病患病率不同

背景：阿巴拉契亚地区内的地区可能面临着被诊断为阿兹海默氏病和相关疾病（ADRD）更大的负担。目的：评估俄亥俄州阿巴拉契亚县的ADRD患病率，并确定在地理位置（阿巴拉契亚/非阿巴拉契亚和农村/城市）以及医疗保险受益人之间是否存在差异。方法：使用2007年至2017年的医疗保险和医疗补助服务公共使用文件中心来估算俄亥俄州所有付费服务受益人的县级ADRD患病率。通过阿巴拉契亚区域委员会的阿巴拉契亚/非阿巴拉契亚名称，以及农村/城市（农村-城市连续体代码）分类，使用负二项式回归来整体估计患病率。重复模型，以适应县级人口统计学和合并症。结果：阿巴拉契亚人居住地和农村地区的ADRD患病率不同（p = 0.008）。在按县级人口统计学和合并症进行调整之前，城市阿巴拉契亚县的ADRD患病率比非阿巴拉契亚县城市低1-3％，而农村阿巴拉契亚县的患病率比农村非阿巴拉契亚县高2-3％ 。调整后，患病率之间的差异更加明显。农村阿巴拉契亚县的患病率一直较高，但在整个研究期间，城市县的患病率有所不同（2007年为1.03,2017年为0.97）。结论：结果表明，俄亥俄州的ADRD负担不同，在阿巴拉契亚农村县的患病率较高。阿巴拉契亚地区的这一潜在差异对于考虑服务的可获得性和后续护理的提供至关重要。为了更好地了解这种差异，有必要进行进一步的流行病学研究，以更好地估计ADRD的负担。