# Role of Geography on Alzheimer’s Disease and Related Dementias in Central Appalachia

> **NIH NIH R03** · OHIO STATE UNIVERSITY · 2022 · $74,034

## Abstract

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.

## Key facts

- **NIH application ID:** 10509690
- **Project number:** 1R03AG078979-01
- **Recipient organization:** OHIO STATE UNIVERSITY
- **Principal Investigator:** Jeffrey James Wing
- **Activity code:** R03 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $74,034
- **Award type:** 1
- **Project period:** 2022-08-15 → 2024-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10509690

## Citation

> US National Institutes of Health, RePORTER application 10509690, Role of Geography on Alzheimer’s Disease and Related Dementias in Central Appalachia (1R03AG078979-01). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10509690. Licensed CC0.

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