Rural-Urban Disparities in Diagnosis of Early-Onset Dementia

作者：Wendy Xu, Jeah Kyoungrae Jung, Sheldon M. Retchin, Yiting Li, Soumyadipta Roy · 发表于：JAMA Network Open · 年份：2022 · DOI：10.1001/jamanetworkopen.2022.25805 · 被引用次数：59 · 研究领域：Dementia and Cognitive Impairment Research、Alzheimer's disease research and treatments、Geriatric Care and Nursing Homes

Importance: Limited access to appropriate specialists and testing may be associated with delayed diagnosis and symptom management for patients with early-onset Alzheimer disease and related dementias (ADRDs). Objectives: To examine rural vs urban differences in diagnostic and symptom management service use among patients with early-onset ADRDs. Design, Setting, and Participants: This cross-sectional study was conducted using commercial claims from 2012 to 2017. Included patients were those with early-onset ADRDs aged 40 to 64 years, including new patients, defined as those with no claims of ADRDs for 36 months before the first ADRD diagnosis. The likelihood of receiving diagnostic and symptom management services was estimated, with adjustment for individual-level variables associated with health care use. Data were analyzed from February 2021 to March 2022. Exposures: Rural residence. Main Outcomes and Measures: Among patients with new, early-onset ADRDs, use of psychological assessment and neuropsychological testing performed at the initial diagnosis (index date) or 90 days or less after the index date and use of brain imaging during the 180 days before the index date were collected. Access to different clinicians on the index date or 90 days or less after the index date was also collected, including visits to primary care physicians and nurse practitioners (PCPs) and specialty visits to psychologists, neurologists, and psychiatrists. Results: Among 71 799 patients with earl...