Rural-urban disparities in the clinical diagnostic pathway of patients with all-cause mild cognitive impairment and dementia due to Alzheimer's disease in Australia
Xiaoping Lin, Mohammad Amin Honardoost, Susannah Ahern, Colman Taylor, Stephanie Ward, Elisabeth de Laguiche, Elizabeth Adesanya, Henry Brodaty, Jonathan Pearson-Stuttard, Sara Holloway, Michael WoodwardBackground
Access to high-quality and timely dementia diagnoses varies between rural and urban location.
Objective
We examined rural-urban disparities in key indicators for high-quality and timely diagnoses of mild cognitive impairment (MCI) and Alzheimer's disease (AD) dementia in Australia.
Methods
3648 patients with all-cause MCI or AD dementia were geographically classified into major cities (75.7%), inner (15.8%) and outer (8.4%) regional areas. We used regression analyses to assess rural-urban disparities in completion of key diagnostic investigations and diagnostic wait times.
Results
Participants in inner regional areas were more likely (odds ratio [OR] = 1.55; 95% confidence interval [CI] = 1.14, 2.13; p = 0.006) to have had more basic diagnostic investigations completed (including core blood tests, cognitive assessments, functional assessments, structural neuroimaging) compared to those in major cities. However, participants in inner regional (OR = 0.37; 95% CI = 0.28, 0.48; p < 0.001) and outer regional (OR = 0.32; 95% CI = 0.21, 0.48; p < 0.001) areas were less likely to have functional neuroimaging completed. Median wait times for an initial appointment following referral to a memory clinic were up to 28 days longer for rural compared to urban participants (Inner regional: Beta (median) = 12.91; 95% CI = 5.15, 20.69; p = 0.001; Outer regional: Beta (median) = 27.50; 95% CI = 18.80, 36.20; p < 0.001), whereas median wait times from initial appointment to diagnosis were up to 47 days shorter in rural compared to urban residents (Inner regional: Beta (median) = −46.83; 95% CI = −52.35, −41.32; p < 0.001; Outer regional: Beta (median) = −44.42; 95% CI = −50.35, −38.49; p < 0.001).
Conclusions
Findings suggest disparities in access to advanced diagnostic investigations and timely initial appointments in rural Australia, and increased need for enhanced workforce and diagnostic infrastructure in these areas.