Rural-Urban mild cognitive impairment comparison in West Michigan through EHR

IF 4.9 Q1 CLINICAL NEUROLOGY Alzheimer''s and Dementia: Translational Research and Clinical Interventions Pub Date : 2024-08-12 DOI:10.1002/trc2.12495

Xiaodan Zhang, Martin Witteveen-Lane, Christine Skovira, Aakash A. Dave, Jeffrey S. Jones, Erin R. McNeely, Michael R. Lawrence, David G. Morgan, Dave Chesla, Bin Chen

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Abstract

INTRODUCTION

Mild cognitive impairment (MCI) is a significant public health concern and a potential precursor to Alzheimer's disease (AD). This study leverages electronic health record (EHR) data to explore rural-urban differences in MCI incidence, risk factors, and healthcare navigation in West Michigan.

METHODS

Analysis was conducted on 1,528,464 patients from Corewell Health West, using face-to-face encounters between 1/1/2015 and 7/31/2022. MCI cases were identified using International Classification of Diseases (ICD) codes, focusing on patients aged 45+ without prior MCI, dementia, or AD diagnoses. Incidence rates, cumulative incidences, primary care physicians (PCPs), and neuropsychology referral outcomes were examined across rural and urban areas. Risk factors were evaluated through univariate and multivariate Cox regression analyses. The geographic distribution of patient counts, hospital locations, and neurology department referrals were examined.

RESULTS

Among 423,592 patients, a higher MCI incidence rate was observed in urban settings compared to rural settings (3.83 vs. 3.22 per 1,000 person-years). However, sensitivity analysis revealed higher incidence rates in rural areas when including patients who progressed directly to dementia. Urban patients demonstrated higher rates of referrals to and completion of neurological services. While the risk factors for MCI were largely similar across urban and rural populations, urban-specific factors for incident MCI are hearing loss, inflammatory bowel disease, obstructive sleep apnea, insomnia, being African American, and being underweight. Common risk factors include diabetes, intracranial injury, cerebrovascular disease, coronary artery disease, stroke, Parkinson's disease, epilepsy, chronic obstructive pulmonary disease, depression, and increased age. Lower risk was associated with being female, having a higher body mass index, and having a higher diastolic blood pressure.

DISCUSSION

This study highlights rural-urban differences in MCI incidence and access to care, suggesting potential underdiagnosis in rural areas likely due to reduced access to specialists. Future research should explore socioeconomic, environmental, and lifestyle determinants of MCI to refine prevention and management strategies across geographic settings.

Highlights

Leveraged EHRs to explore rural-urban differences in MCI in West Michigan.
Revealed a significant underdiagnosis of MCI, especially in rural areas.
Observed lower rates of neurological referrals and completions for rural patients.
Identified risk factors specific to rural and urban populations.

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通过电子病历对西密歇根州的城乡轻度认知障碍进行比较。

导言：轻度认知障碍（MCI）是一个重大的公共卫生问题，也是阿尔茨海默病（AD）的潜在前兆。本研究利用电子健康记录（EHR）数据，探讨西密歇根州在 MCI 发病率、风险因素和医疗保健导航方面的城乡差异：分析对象是来自 Corewell Health West 的 1,528,464 名患者，使用的是 2015 年 1 月 1 日至 2022 年 7 月 31 日期间的面对面就诊记录。MCI病例使用《国际疾病分类》（ICD）代码进行识别，重点关注年龄在45岁以上、之前未确诊为MCI、痴呆症或注意力缺失症的患者。对农村和城市地区的发病率、累计发病率、初级保健医生 (PCP) 和神经心理学转诊结果进行了研究。通过单变量和多变量 Cox 回归分析对风险因素进行了评估。研究还考察了患者人数、医院位置和神经科转诊的地理分布情况：在 423,592 名患者中，城市地区的 MCI 发病率高于农村地区（每千人年 3.83 对 3.22）。然而，敏感性分析显示，如果将直接发展为痴呆症的患者包括在内，农村地区的发病率更高。城市患者转诊到神经科并完成治疗的比例较高。虽然 MCI 的风险因素在城市和农村人口中大体相似，但听力损失、炎症性肠病、阻塞性睡眠呼吸暂停、失眠、非裔美国人和体重过轻是导致 MCI 发生的城市特有因素。常见的风险因素包括糖尿病、颅内损伤、脑血管疾病、冠状动脉疾病、中风、帕金森病、癫痫、慢性阻塞性肺病、抑郁症和年龄增长。女性、体重指数较高和舒张压较高的人患病风险较低：讨论：本研究强调了 MCI 发病率和就医机会方面的城乡差异，表明农村地区可能因就医机会减少而导致诊断不足。未来的研究应探讨MCI的社会经济、环境和生活方式等决定因素，以完善不同地域的预防和管理策略：利用电子病历探索西密歇根州 MCI 的城乡差异，发现 MCI 的诊断率明显偏低，尤其是在农村地区。

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来源期刊

Alzheimer''s and Dementia: Translational Research and Clinical Interventions Medicine-Psychiatry and Mental Health

CiteScore

10.10

自引率

2.10%

发文量

134

审稿时长

10 weeks

期刊介绍： Alzheimer''s & Dementia: Translational Research & Clinical Interventions (TRCI) is a peer-reviewed, open access,journal from the Alzheimer''s Association®. The journal seeks to bridge the full scope of explorations between basic research on drug discovery and clinical studies, validating putative therapies for aging-related chronic brain conditions that affect cognition, motor functions, and other behavioral or clinical symptoms associated with all forms dementia and Alzheimer''s disease. The journal will publish findings from diverse domains of research and disciplines to accelerate the conversion of abstract facts into practical knowledge: specifically, to translate what is learned at the bench into bedside applications. The journal seeks to publish articles that go beyond a singular emphasis on either basic drug discovery research or clinical research. Rather, an important theme of articles will be the linkages between and among the various discrete steps in the complex continuum of therapy development. For rapid communication among a multidisciplinary research audience involving the range of therapeutic interventions, TRCI will consider only original contributions that include feature length research articles, systematic reviews, meta-analyses, brief reports, narrative reviews, commentaries, letters, perspectives, and research news that would advance wide range of interventions to ameliorate symptoms or alter the progression of chronic neurocognitive disorders such as dementia and Alzheimer''s disease. The journal will publish on topics related to medicine, geriatrics, neuroscience, neurophysiology, neurology, psychiatry, clinical psychology, bioinformatics, pharmaco-genetics, regulatory issues, health economics, pharmacoeconomics, and public health policy as these apply to preclinical and clinical research on therapeutics.