Rural-urban and within-rural disparities in Alzheimer's disease and Alzheimer’s disease-related dementias

PROJECT ABSTRACT This application proposes to examine where and for whom rural residence is associated with Alzheimer’s disease and Alzheimer’s disease-related dementias (AD/ADRD) in the United States. Analyses will 1) produce novel and robust estimates of dementia prevalence in rural and urban America; and 2) characterize the types of rural places

and people most affected by dementia. This research is motivated by growing concerns for the health of rural Americans, roughly 46 million people and 14% of the U.S population. Rural Americans have had poorer health profiles than their urban peers since at least the 1980s, and the gap has widened over time. Yet surprisingly little

is known about rural-urban disparities in dementia, which is poised to become one of the most significant population health challenges of the century. Dementia currently affects approximately 6.1 million or 11% of Americans ages 65 and older, and numbers are expected to rise dramatically in the coming decades due to

population aging. The challenges associated with dementia may be especially severe in rural communities, where access to quality healthcare and other services for people with dementia and their caregivers is often severely limited. To anticipate and plan for the challenges associated with dementia, its patterning across places

and people must be understood. However, demographic estimates of dementia prevalence in rural and urban America are lacking, even at the national level. Moreover, it remains unknown how the prevalence of dementia varies among rural places and people, despite the fact that rural America is not monolithic. The proposed project

will therefore develop a demographic overview of rural-urban dementia disparities, including novel analyses of heterogeneity across places (Aim 1) and people (Aim 2). In particular, Aims will explore variation in dementia prevalence at the intersections of rural residence and regional setting (Aim 1a), county context and composition

(Aim 1b), and individual-level sociodemographic characteristics (Aim 2). Analyses will be conducted with data from the Health and Retirement Study, a nationally representative survey of older U.S. adults. This application, led by an early-stage investigator, responds to PAR-23-179, which encourages applications generating scientific

insights about AD/ADRD, including estimates of disparities, from early-stage investigators and established researchers new to the study of AD/ADRD.