Project Summary/Abstract Geographic variation in Alzheimer’s disease and related dementias (ADRD) prevalence exists, but the mechanisms driving these disparities remain unknown. The two most likely and non-exclusive explanations for geographic variation in ADRD are: 1. disparities in patterning of sociodemographic factors (e.g. rural residents may be at a greater risk of ADRD due to lower educational attainment) and/or 2. differences in disease detection rates (e.g. rural residents may have reduced access to and quality of health care services and thus fewer dementia diagnoses regardless of the true prevalence). As rural areas have lower reported ADRD prevalence compared to urban areas in spite of lower educational attainment (which should lead to higher ADRD prevalence) this argues that the true burden of ADRD in likely underestimated in areas without adequate detection resources. There is need to understand if ADRD prevalence is truly lower in rural areas, or if this is a disease detection difference. The objective of this proposal is to assess the burden of ADRD in Central Appalachia. By using geographic characteristics to assess the association between geographic variation, socio-demographic factors, and access to care (e.g. primary care physicians (PCPs), neurologists) we will understand how patterns of care influence ADRD diagnoses and which parts of the country may have relatively over- or underestimated ADRD prevalence due to differences in care intensity. 1. We will verify regional differences in ADRD prevalence across the Central Appalachian region using stratified negative binomial regression models. Working hypothesis: Rural counties will have lower ADRD prevalence, as will Appalachian counties relative to urban and non-Appalachian counties, respectively. 2. Socio-demographic and access to care factors will be included in existing negative binomial models to assess their contribution to regional differences in ADRD prevalence. Working hypothesis: socio-demographic and access factors partially explain/attenuate variations in ADRD prevalence. This proposal addresses the objectives of PAS-19-391 in several ways: 1. The Principal Investigator (PI) is an early stage investigator committed to ADRD; 2. The PI has experience with using CMS data, census data, and other existing aggregate data sources; and 3. The PI has published using these data in describing geographic differences in ADRD prevalence in Ohio. This project would represent the next step in better understanding of regional differences in ADRD prevalence and provide critical data toward the role of access to care in estimating ADRD prevalence.