Access to healthcare for people with Alzheimer's Diseases and related dementias

Background: Alzheimer's Disease and Related Dementias (ADRD) affects millions worldwide. Significant disparities exist in ADRD diagnosis and care, disproportionately impacting minority and socioeconomically vulnerable populations Objective: In this study, we investigate the relationship between ADRD density and accessibility to healthcare. We identify underserved and overserved areas in Maryland based on diagnosed cases and mortality due to ADRD, focusing on geographic disparities in care. Methods: 2023 Maryland ADRD patients were identified using ICD-10 codes from. Accessibility was measured using the Kernel Density Two-Step Floating Catchment Area (KD2SFCA) method. The Gini index and t-tests were used to analyze disparities between urban and rural areas. Hot Spot Analysis Getis-Ord Gi* and local bivariate relationships analysis were applied to assess spatial correlations. Principal component analysis (PCA) was applied to calculate the health risk index. Results: Hospital accessibility was unevenly distributed. Mortality rates from ADRD were higher in underserved areas with fewer hospitals. Hot spot analysis shows eastern and southern Maryland have zones with high mortality per population and per ADRD patient, surrounded by similarly high-rate zones. Central Maryland shows lower death rates per patient but more hospital facilities. In eastern Maryland, higher poverty areas are surrounded by zones with lower accessibility and higher health risk indices. Conclusion: Hospital accessibility is unevenly distributed, creating major rural disparities. Underserved regions in terms of access to healthcare facilities, particularly in eastern and southern Maryland, exhibit high ADRD mortality rates despite low diagnosis rates. This suggests that many ADRD cases remain undiagnosed, underdiagnosed, or subject to delayed treatment.