Rural–urban disparities of Alzheimer's disease and related dementias: A scoping review

IF 4.9 Q1 CLINICAL NEUROLOGY

Alzheimer''s and Dementia: Translational Research and Clinical Interventions Pub Date : 2025-02-11 DOI:10.1002/trc2.70047

Mackenzie Kramer, Maxwell Cutty, Sara Knox, Alexander V. Alekseyenko, Abolfazl Mollalo

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Abstract

The rising age of the global population has made Alzheimer's disease and related dementias (ADRD) a critical public health problem, with significant health-related disparities observed between rural and urban areas. However, no previous reviews have examined the scope and determinant factors contributing to rural–urban disparities of ADRD-related health outcomes. This study aims to systematically collate and synthesize peer-reviewed articles on rural–urban disparities in ADRD, identifying key determinants and research gaps to guide future research. We conducted a systematic search using key terms related to rural–urban disparities and ADRD without restrictions on geography or study design. Five search engines—MEDLINE, CINAHL, Web of Science, PubMed, and Scopus—were used to identify relevant articles. The search was performed on August 16, 2024, and included English-language articles published from 2000 onward. Sixty-three articles met the eligibility criteria for data extraction and synthesis. Most articles were published after 2010 (85.7%) and were concentrated in the United States, China, and Canada (66.7%). A majority had cross-sectional (58.7%) or cohort study designs (23.8%), primarily examining prevalence (41.3%) or incidence (11.1%). Findings often indicated a higher prevalence and incidence in rural areas, although inconsistent rural–urban classification systems were noted. Common risk factors included female sex, lower education level, lower income, and comorbidities such as diabetes and cerebrovascular diseases. Environmental (12.7%) and lifestyle (14.3%) factors for ADRD have been less explored. The statistical methods used were mainly traditional analyses (e.g., logistic regression) and lacked advanced techniques such as machine learning or causal inference methods. The gaps identified in this review emphasize the need for future research in underexplored geographic regions and encourage the use of advanced methods to investigate understudied factors contributing to ADRD disparities, such as environmental, lifestyle, and genetic influences.

Highlights

Few studies on rural–urban ADRD disparities focus on low- and middle-income countries.
Common risk factors include female sex, low education attainment, low income, and comorbidities.
Inconsistent definitions of “rural” complicate cross-country comparisons.
Environmental and lifestyle factors affecting ADRD are underexplored.
Advanced statistical methods, such as machine learning and causal inference, are recommended.

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阿尔茨海默病和相关痴呆的城乡差异：范围综述

全球人口老龄化使阿尔茨海默病和相关痴呆（ADRD）成为一个严重的公共卫生问题，农村和城市地区在健康方面存在显著差异。然而，以前没有审查影响城乡adrd相关健康结果差异的范围和决定因素。本研究旨在系统整理和综合有关ADRD城乡差异的同行评议文章，找出关键决定因素和研究差距，以指导未来的研究。我们在不受地理或研究设计限制的情况下，使用与城乡差异和ADRD相关的关键术语进行了系统搜索。五个搜索引擎- medline， CINAHL, Web of Science， PubMed和scopus -被用来识别相关文章。搜索于2024年8月16日进行，包括2000年以后发表的英文文章。63篇文章符合数据提取和综合的资格标准。大部分文章发表于2010年之后（85.7%），主要集中在美国、中国和加拿大（66.7%）。大多数采用横断面研究（58.7%）或队列研究（23.8%），主要检查患病率（41.3%）或发病率（11.1%）。调查结果往往表明农村地区的患病率和发病率较高，尽管注意到城乡分类制度不一致。常见的危险因素包括女性、受教育程度较低、收入较低以及糖尿病和脑血管疾病等合并症。环境因素（12.7%）和生活方式因素（14.3%）对ADRD的研究较少。使用的统计方法主要是传统的分析（如逻辑回归），缺乏先进的技术，如机器学习或因果推理方法。本综述中发现的差距强调需要在未开发的地理区域进行未来研究，并鼓励使用先进的方法来调查导致ADRD差异的未充分研究的因素，如环境、生活方式和遗传影响。关于城乡ADRD差异的研究很少关注低收入和中等收入国家。常见的危险因素包括女性、受教育程度低、收入低和合并症。不一致的“农村”定义使跨国比较复杂化。影响ADRD的环境和生活方式因素尚未得到充分研究。建议使用先进的统计方法，如机器学习和因果推理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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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.