Neighborhood Deprivation and Mortality Risk among Medicare Beneficiaries with Alzheimer’s Disease and Related Dementia

Abstract

AbstractBackgroundAlzheimer’s Disease (AD) and Related Dementias (ADRD) is a class of progressive fatal degenerative diseases that presents multiple causations and outcomes related to its biological, medical, and social determinants of health (SDoH). Studies have extensively explored biological and medical factors, however, SDoH, which is known to contribute to structural inequities in health outcomes, is understudied. We aimed to study the association between neighborhood deprivation (an important SDoH measurement of socioeconomic disadvantage), and the risk of mortality among older adults diagnosed with AD/ADRD.MethodUsing a 5% random sample of national Medicare claims data, we identified individuals newly diagnosed with ADRD in 2006‐2013. The outcome of interest was all‐cause mortality. The exposure of interest was area deprivation index (ADI), a validated neighborhood deprivation measure that incorporates factors of poverty, education, housing, and employment. ADI was spatiotemporally linked to the study cohort using 9‐digit ZIP codes and index scores were classified into 6 categories: quartiles plus the 10th and 90th percentile. We applied generalized estimation equations to model an odds ratio (OR) of mortality across the ADI categories while adjusting for demographic and clinical factors. Subgroup analyses were modeled within urban and rural areas, respectively.ResultsWe included 74,462 patients with ADRD diagnosis, with a mean age of 82 (SD: 8.2) years; 72.3% were women and 65.8% (n = 31218) died over a median follow‐up of 3.5 years. A dose‐gradient association between the ADI and all‐cause mortality was observed in the ADRD population, with the risk of mortality gradually increasing with greater deprivation (Table). The dose‐gradient association between ADI and mortality remained after stratifying by urban and rural areas. ADRD patients in rural areas had a higher mortality risk than those in urban areas (Table).ConclusionOur findings suggest neighborhood deprivation is an important risk factor of mortality among older adults with ADRD while accounting for individuals’ demographic and clinical characteristics. The current results underscore the need for the design and implementation of intervention and policy programs to address structural disparities in outcomes of ADRD patients.