Racial, ethnic, and rural disparities in distance to physicians among decedents with Alzheimer's disease and related dementias in Washington State

Abstract

Introduction: Distance to physicians may explain some of the disparities in Alzheimer's disease and related dementia (AD/ADRD) outcomes.

Methods: We generated round trip distance between residences of decedents with AD/ADRD and the nearest neurologist and primary care physician in Washington State.

Results: The overall mean distance to the nearest neurologist and primary care physician was 17 and 4 miles, respectively. Non-Hispanic American Indian and/or Alaska Native and Hispanic decedents would have had to travel 1.12 and 1.07 times farther, respectively, to reach the nearest neurologist compared to non-Hispanic White people. Decedents in micropolitan, small town, and rural areas would have had to travel 2.12 to 4.01 times farther to reach the nearest neurologist and 1.14 to 3.32 times farther to reach the nearest primary care physician than those in metropolitan areas.

Discussion: These results underscore the critical need to identify strategies to improve access to specialists and primary care physicians to improve AD/ADRD outcomes.

Highlights: Distance to neurologists and primary care physicians among decedents with AD/ADRD American Indian and/or Alaska Native decedents lived further away from neurologists Hispanic decedents lived further away from neurologists Non-metropolitan decedents lived further away from neurologists and primary care Decrease distance to physicians to improve dementia outcomes.

Keywords: Alzheimer's disease; American Indian and/or Alaska Native; Hispanic; access to physician; dementias; rurality.

FIGURE 1

Routes from decedents’ residence with an underlying or associated cause of Alzheimer's disease or other dementias to the nearest primary care physician (PCP) and neurologist overlaid on cluster analysis of cold spots (spatial clusters of census tracts with shorter distances to the nearest physicians), hot spots (spatial clusters of census tracts with longer distances to the nearest physicians), and neutral zones (areas that cannot be classified as either hot or cold). Authors’ analysis of data from the Washington State Department of Health for years 2011–2021 and American Medical Association for year 2016.