Alzheimer’s and other dementia diagnoses can vary by zip code, new study finds

Your home address could determine the likelihood of getting a dementia diagnosis, a new study suggests.

Researchers from University of Michigan Medical School analyzed Medicare claims for nearly five million older adults in regional health care markets across the country — focusing on the areas that had higher rates of diagnoses of Alzheimer’s disease and other dementias.

They found that in areas with a higher rate of diagnosis — known as "diagnosis intensity" — residents were twice as likely to find out they had the condition, especially among those ages 66 to 74, along with Black and Hispanic subgroups.

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"The number of people who obtain a formal diagnosis is different across regions," lead study author Dr. Julie Bynum, a researcher and professor in the Department of Internal Medicine at University of Michigan Medical School, told Fox News Digital.

"Those differences are related to how many people actually have dementia, which is driven by risk factors like age, race and cardiovascular risks — but we cannot explain all the differences in the percentage of people who get diagnosed on these population characteristics." 

Certain health system factors may come into play, Bynum said – such as the accessibility of health care and the availability of clinicians who have experience in diagnosing and caring for people with dementia. 

Some of the health care markets with the highest dementia diagnosis rates include Texas (McAllen, Wichita Falls, Harlingen); Miami, Florida; Lake Charles, Louisiana; Alabama (Tuscaloosa and Montgomery); Michigan (Detroit, Dearborn, Royal Oak); Oxford, Mississippi; and New York (Bronx, Manhattan).

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Bynum wasn’t entirely surprised by the findings, she said.

She expected to find differences in the rate of formal diagnosis, she said, based on how practices and individual doctors typically respond to patients with cognitive concerns. 

"What was less expected is that the location of high and low diagnosis intensity areas does not follow a pattern of where there is a higher burden of disease in the population," she said. 

"I had expected that in places where dementia was a bigger problem, we might see a greater effort to get those people into care."

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Lycia Neumann, PhD, senior director of health services research at the Alzheimer's Association, was not involved in the study but commented on how it highlights regional disparities in the diagnosis of Alzheimer’s and other dementias.

"This suggests that unless there is intentional effort from health systems, payers and governments to promote equitable access to diagnosis, these disparity gaps will continue growing," she told Fox News Digital.

Overcoming barriers to diagnosis

Based on the findings, people who are concerned about cognitive decline among their family members may need to "put in some extra effort" in communicating their concerns with their primary doctors, Bynum said. 

"One of the problems is that the concern can get lost among all the other things older adults and their doctors address, and sorting out cognitive complaints is challenging for doctors," she told Fox News Digital. 

"In addition, we should all be encouraging our local health systems to develop the capacity to address the needs of this burgeoning population through clinical and supportive programming."

Neumann said younger individuals and those from "historically underrepresented ethnic and racialized groups" have a greater risk of being underdiagnosed. 

"We know that barriers to an early and precise dementia diagnosis exist at all levels," she said.

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"They go from stigma and lack of awareness of signs and symptoms to barriers to health care access related to health insurance coverage, distance to clinical settings, and lack of transportation and companionship."

It is Neumann’s hope, she said, that studies like this one spark efforts to raise awareness of early warning signs and encourage individuals to discuss any concerns with their health care providers.

"Barriers to an early and precise dementia diagnosis exist at all levels."

Educational programs and interventions can also facilitate access to timely dementia diagnoses, she added. 

"After all, an accurate diagnosis is the first step to appropriate treatment and care."

Potential limitations

One of the study’s limitations is that the researchers were not able to determine whether the rate of diagnosis is "too high or too low" based only on their data, Bynum noted.

"We can only say that it is higher or lower than the national average rate," she said.  

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"We would need to know the actual number of people living with dementia in each community, which would be incredibly costly to measure."

This approach, however, can help researchers understand whether getting a formal diagnosis is more or less difficult across geographical areas, according to Bynum.

"There are always limitations regarding studies based on claims data," Neumann noted. 

"Claims data are only about individuals who received care, in this case a diagnosis — so it excludes people who might be living with the disease but haven’t been able to access the health care system or haven’t received an accurate diagnosis."

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Additionally, the information collected in medical claims is for payment and reimbursement purposes, not for research — so it doesn’t allow for the understanding of the factors that might be driving the disparities, she added. 

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The study population is also only composed of older adults enrolled in Medicare fee-for-service, or traditional Medicare, Neumann noted.