CNN
—
Imagine this: you and your sister are 66-year-old twins on Medicare, with a family history of Alzheimer’s disease, and early diagnosis is important for long-term planning and preventative care. Medicare provides Providing coverage Cognitive screening I believe that diagnostics will be done as needed as part of your annual health check.
For example, let’s say you live in Hartford, Connecticut. Your sister lives about 26 miles away in Springfield, Massachusetts. You’re so close you often have Sunday dinner together. But a new study suggests that you’re 18% more likely to be diagnosed with dementia in Hartford than your sister in Springfield.
Why is this happening? Medicare data suggests that Connecticut’s health care system may be doing a better job than Massachusetts at testing for and diagnosing Alzheimer’s disease and related dementias and referring patients to specialists, said Julie Bynum, a professor of internal medicine, geriatrics and palliative medicine at the University of Michigan Medical School in Ann Arbor and lead author of the study.
Bynum said these disparities are occurring across the U.S., noting that in fact, some zip codes in some parts of the U.S. are twice as likely to be diagnosed as others.
Compared to the national average, 28% of people live in zip codes with the lowest diagnostic frequency (a measure of how often doctors offer tests and treatments to patients). Unlikely Research suggests that getting a timely diagnosis is key.
36% live in areas with the highest concentration of diagnoses (where doctors are more likely to treat patients aggressively) More likely Studies have shown that they are less likely to be diagnosed with Alzheimer’s disease or other types of dementia.
“There’s a certain way in different health systems of how you see patients with this disease, regardless of their level of risk,” Bynum said. “Without a diagnosis, you can’t be educated or prepared.”
Bynum had access to ZIP code-by-ZIP code data for his research, but couldn’t release those ZIP codes due to Medicare privacy restrictions. The map below, which CNN created from the study, shows an overview of which states and regions fared better and worse.
The study highlights that patients receive different treatment “depending on where they live and what their status is,” “and that’s not fair,” said Dr. Eseosa Ighodaro, an associate professor of neurology at Atrium Health Wake Forest Baptist Medical Center and the Maya Angelou Center for Health Equity in Winston-Salem, North Carolina.
“This study is timely because we now have medications that we can give to patients with mild cognitive impairment due to Alzheimer’s disease that we didn’t have before 2021,” said Ighodaro, who was not involved in the new study.
“If we don’t do something about these disparities, there will be people who won’t have access to these disease-modifying therapies,” she added. “And that’s terrible.”
Early diagnosis can mean people can qualify for clinical trials and receive specialized treatment and care, improving their quality of life, said Licia Newman, senior director of health services research at the National Cancer Center. Alzheimer’s AssociationShe was not involved in the new study.
“Everyone has an equal right to receive this diagnosis, it’s the first step to understanding why you’re noticing the signs and symptoms and changing how you live your daily life and interact with your family,” Newman said.
“Knowing where the disparities exist is the first step in us addressing them,” she added. “We need to do more. We need to make sure these differences don’t exist.”
Traditionally, studies have shown that most cases of Alzheimer’s and dementia occur in theStroke BeltThe mortality rate from stroke is According to the U.S. Centers for Disease Control and Prevention, there are more cases in the state than in any other region.
“But obesity is widespread across the United States, as are high blood pressure, type 2 diabetes, heart disease and other conditions that lead to dementia,” Bynum says. “So why are the majority of diagnoses concentrated in the South?”
To find out, she and her team spent years analyzing Medicare claims data from 306 states. Hospital Referral Area In the United States, a hospital referral area is the collection of zip codes where the hospitals, doctors, and specialists in that area provide most of the medical care for its residents.
The research team compared the number of Medicare diagnoses of dementia among people aged 66 and over in each area in 2019 with the potential number of new cases in that area. Modifiable Risk Factors Risk factors for dementia include alcohol consumption, low education level, depression, diabetes, high blood pressure, obesity, smoking and few social contacts.
Known demographic and health risk factors were removed, allowing the team to obtain a measure of diagnostic intensity that differed from the traditional view: No longer was there an emphasis on the Southeast, but instead the map showed diagnostic differences across the country.
For example, Alaska, Connecticut and the Texas Panhandle found excellent agreement between dementia diagnoses and symptoms expected in those areas, according to a study recently published in the journal Neurology. Alzheimer’s and Dementia.
Surprisingly, Florida did not.
“It’s estimated that 30% to 40% of people over 80 have some form of dementia, so one would expect Florida, with its large Medicare elderly population, to have a higher rate of dementia diagnoses than other parts of the country,” Bynum said. “But our findings did not show that this was the case.”
Hospital regions also showed wide variations in the rates of new diagnoses of Alzheimer’s disease and other dementias, with some regions seeing just 1.7% of their elderly population diagnosed – the lowest rate found in the study – and others seeing 5.4% of their elderly population diagnosed – the highest rate.
The biggest differences were seen in the youngest age group, 66-74 years old, who may benefit most from lifestyle changes and early-stage Alzheimer’s medication, and The risk is much higher More than white people Alzheimer’s and other dementias.
“Even within the black community, we see a two-fold difference in the likelihood that an individual will be diagnosed depending on their zip code,” Bynum said. “So this isn’t just about group characteristics. There’s something going on.”
Insurance coverage, stigma, and doctor overwork
Although all patients in the study had the same insurance plan (Medicare), there are differences between health systems with regard to the number of hospitals and specialists that accept the government insurance program. Fee-for-service medical insurance system.
“If you live in a city where the local hospital doesn’t accept Medicare and you live in another city where the local hospital does accept Medicare, that might explain some of the difference,” Ighodaro says. “Both patients have Medicare, but they have different access to care and treatment.”
Even if a local health system accepts Medicare, that doesn’t mean the program will cover the tests needed to confirm a suspected diagnosis, she added.
“Biomarkers, Neuropsychological testingMRI or Pets “Scans are not necessarily covered by Medicare or other insurances,” Ighodaro says, “and if I, as a neurologist, couldn’t perform these tests or order them, it would be difficult for me to make a diagnosis of dementia. But without that diagnosis, patients wouldn’t be eligible for these disease-modifying drugs that could potentially improve their quality of life.”
Cognitive decline carries stigma in some communities and cultures and can affect work and family relationships, Bynum said, so some doctors and patients may feel uneasy about getting a diagnosis. Then there’s the issue of identifying the signs of cognitive decline, which can sometimes be difficult.
“When you think about the older adults who come in, they have three, four, five chronic conditions and multiple physical symptoms, all of which may be impacting their cognitive function,” Bynum says. “I’m a geriatrician, and I can tell you that diagnosing cognitive decline is not always easy.”
So how can you ensure you get the cognitive testing you need at your annual physical? Be your own advocate, Ighodalo said. Call ahead to see if your doctor or hospital offers such an evaluation as part of your physical, and keep looking for those that do, she said. Another tip: call your insurance company ahead of time to find out what kind of additional cognitive testing will be covered, if you really need it.
“If you have any concerns about your or your family’s cognitive abilities, get tested,” Ighodaro says. “Having a doctor reassure you that there’s nothing to worry about is better than waiting and not getting a new medication.”
“Remember, it’s not the patient’s job to say, ‘this is dementia or this isn’t dementia.’ It’s our job.”
