Supplementary Material

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Background: Alzheimer's disease is a known form of dementia that causes a person to experience the inabilities to perform daily tasks. One determinant of this disease is geographical location where variations in terms of diagnosis and prevalence of Alzheimer's disease and related disorders (ADRD) may exist. This study aims to investigate the likelihood that patients residing in rural areas are less likely to be diagnosed with ADRD compared to those living in urban communities.

Methods: An ecologic study design is utilized to investigate the association between the outcome, ADRD prevalence among Medicare beneficiaries, and the exposure of living in rural counties. The Centers for Medicare & Medicaid Services Public Use Files data is used to examine the prevalence of county-level ADRD among all Medicare beneficiaries in Arkansas and Louisiana in the year 2013. A special coding system called the Rural-Urban Continuum Codes is employed for counties classification. The performed analysis employed Poisson regression to investigate and adjust prevalence ratios.

Results: Medicare beneficiaries living in rural counties showed a very slight increase, yet insignificant, in the diagnostic prevalence of ADRD by 0.003 (95% CI: -0.06–0.06), after adjusting for state, average age, race, percent of female beneficiaries, percent of Medicaid eligibility, percent of county population aged 65+ & < 64 who were enrolled in Medicare, other comorbidities, and chronic diseases.

Conclusion: There is no significant evidence to suggest that Medicare beneficiaries living in rural counties in Arkansas and Louisiana have a lower diagnostic prevalence of ADRD compared to their urban counterparts.