New research shows that where a person lives can determine whether they receive timely diagnosis and care, or instead fall through the cracks.
A new statewide mapping study of Alzheimer’s disease and related dementias (ADRD) highlights sharp gaps between Maryland’s urban and rural communities, showing how access to healthcare can directly influence who gets diagnosed and treated.
The findings were recently presented at the Society for Risk Analysis (SRA) Annual Conference.
Across the U.S., more than 90% of larger hospitals are based in cities, leaving rural hospitals with fewer resources and extremely thin operating margins. Researchers found that a major barrier is staffing. Doctors, nurses, and specialists trained in Alzheimer’s and dementia care are heavily concentrated in urban centers. For rural residents, this often means longer trips to reach appropriate care, a challenge that can be especially difficult for patients over 80 years old.
A Growing National Health Challenge
Alzheimer’s disease affects more than 6.9 million Americans, and the Alzheimer’s Association projects that the number of cases will double by 2060. The new research reinforces a troubling reality: where someone lives can help determine whether they receive an early diagnosis and timely support, or whether their condition goes unrecognized.
The study examined 422,735 Maryland patients in 2019 and found patterns suggesting that many ADRD cases may be missed in rural communities. Underserved regions in eastern and western Maryland stood out because they showed high ADRD mortality rates alongside low diagnosis rates, pointing to a potential pool of undiagnosed patients. Hospital access was also unevenly distributed. Urban areas had far stronger access, while rural areas faced reduced availability and higher mortality.
Mapping Risk Through Spatial Analysis
To dig deeper, the researchers used spatial regression analysis (Getis-Ord G* and GWR models). These results linked lower hospital accessibility with higher poverty rates and higher health risk rates, including diabetes and heart disease. The spatial analysis also confirmed that these relationships vary by region, indicating that local conditions play a significant role in shaping ADRD outcomes.
In addition, the society’s analysis identified “hot spots” where Alzheimer’s patients appear to face a lack of medical care across eight counties: Garrett, Allegany, Kent, Calvert, Queen Anne’s, Talbot, St. Mary’s, and Charles. The study’s findings arrive as healthcare systems continue to face funding pressures, conditions that can have serious consequences for older adults and underserved populations.
By connecting hospital access, demographics, and comorbidities like diabetes to ADRD patterns, the research offers evidence that could guide targeted policy responses. The researchers say the patterns identified in Maryland are not unique. Similar gaps in diagnosis, care, and outcomes are likely to be found in rural communities nationwide, underscoring the need for broader, coordinated efforts to address Alzheimer’s care beyond urban centers.
Meeting: Society for Risk Analysis 2025 Conference
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2 Comments
5jjjǰ5h55555
It’s because the best and smartest doctors avoid living in rural areas because the patients are more ignorant and have more mental health problems, substance abuse problems, bad lifestyles and lower intelligence. It must be very frustrating to give medical care to someone who you know is not going to take your advice or medication. Plus, the patients in rural areas are poorer and have health insurance that won’t cover this or that, or doesn’t pay the doctors as much as other better insurance companies. So the doctors make less money off the patients and have more frustrations dealing with them, and are unable to prescribe the treatments/medications that would be best for patients. Even if you come across an intelligent, educated, responsible person who is chronically ill through no fault of their own and can’t work and lives in a rural area simply because they can’t afford to live in a more urban area, the doctors can’t do much to help them so it still bums them out. Good doctors flee rural areas, so people who live in rural areas are stuck with doctors who don’t care, are negligent and careless, and are just bad doctors in general. These doctors are the ones who will miss symptoms, dismiss symptoms and complaints, and subsequently miss diagnosing lots of things, including alzheimers.