Analysis of Alzheimer's disease and related dementias uncovers disparities in Maryland's rural communities

A new statewide spatial analysis of Alzheimer's disease and related dementias (ADRD) has uncovered significant disparities in Maryland's rural communities, offering a striking example of how healthcare accessibility is shaping health outcomes across the United States. 

More than 90% of larger hospitals are located in urban areas, leaving rural hospitals with fewer resources and very small operating margins. One of the biggest challenges is the shortage of doctors, nurses, and specialists trained in Alzheimer's and dementia care, who are concentrated in urban centers. As a result, patients in rural areas, many of whom are over 80 years old, often face the additional burden of traveling much longer distances to access the care they need. 

Alzheimer's disease affects more than 6.9 million Americans, and its prevalence is expected to double by 2060, according to the Alzheimer's Association. This research demonstrates that where a person lives can determine whether they receive timely diagnosis and care or whether they fall through the cracks. 

The study analyzed 422,735 patients in Maryland in 2019, identifying reveal that many ADRD cases may remain in underserved rural areas, particularly in eastern and western Maryland, where high mortality rates coincide with low diagnosis rates. These results come amid ongoing funding challenges serious consequences for older and underserved populations. 

By identifying hospital accessibility, demographic factors, and comorbidities like diabetes ADRD patterns, the study provides evidence that could inform targeted policy interventions in clinics, hospitals, and outreach programs not just in Maryland, but across rural America. 

KEY FINDINGS: 

• Underserved regions in eastern and western Maryland show high ADRD mortality rates despite low diagnosis rates, suggesting that many cases remain undiagnosed. 

• Hospital accessibility is unevenly distributed, with urban areas having significantly better access than rural areas, where mortality rates are elevated. 

• Spatial regression analysis (Getis-Ord G* and GWR models) revealed that lower hospital accessibility is associated with higher poverty rates and higher health risk rates, including diabetes and heart disease. 

• Regional variations in these relationships were confirmed through spatial analysis, demonstrating that localized factors significantly influence ADRD outcomes.