Your ZIP code may determine your dementia diagnosis, study finds

A recent study highlights a surprising and disturbing finding: your ZIP code may significantly influence whether you receive a timely dementia diagnosis. Research shows that certain regions in the U.S. are better equipped to diagnose dementia, leaving others at a disadvantage. According to Dr. Julie Bynum, the lead author of the study, patients in some areas are up to 36% more likely to be diagnosed with dementia, while others may be 28% less likely to receive a diagnosis.¹

Regional Disparities in Diagnosis Rates

The study, published in Alzheimer’s & Dementia, analyzed Medicare data from 2018 and 2019 to investigate how often people aged 66 and older were diagnosed with dementia. Results revealed that diagnosis rates varied widely across different ZIP codes, with some regions showing a higher rate of diagnosis than expected based on local risk factors.² For example, Alaska and Connecticut showed excellent alignment between expected and actual diagnosis rates, while states like Florida and Arizona fell short.

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Health System Factors: A Key Driver

The disparities are largely driven by healthcare access and how available specialists are in diagnosing dementia. In some areas, particularly those with well-established diagnostic research centers or a higher number of trained healthcare providers, patients are more likely to receive an early diagnosis. This discrepancy in healthcare availability is a significant factor in why geography plays such a crucial role in dementia diagnosis.

The Consequences of Late Diagnosis

Delays in diagnosing dementia can have serious consequences. Early diagnosis allows for better management of the disease, including access to medications and clinical trials that could improve quality of life. “Without that diagnosis, you can’t get educated, you can’t prepare,” Dr. Bynum said. Early intervention is especially crucial given the rise of new medications that can slow cognitive decline if administered in the early stages.

The Impact on Black and Hispanic Communities

The study also revealed that Black and Hispanic Americans, already at a higher risk of dementia, face additional challenges in receiving a diagnosis. Cultural factors and historical mistrust of the healthcare system contribute to lower diagnosis rates in these communities. According to Dr. Mollie Richards, historical examples like the Tuskegee experiments continue to foster distrust among Black Americans.

Influence of Insurance and Stigma

While all participants in the study were on Medicare, there are differences in how healthcare systems operate play a role in who gets treatment. Some regions may have hospitals that don’t accept Medicare or lack resources like neuropsychological testing and advanced imaging techniques, which are essential for a definitive dementia diagnosis. Stigma around cognitive decline also prevents some individuals from seeking help early.

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ZIP Codes with the Highest and Lowest Diagnosis Rates

The study uncovered significant disparities in diagnosis rates between hospital regions. In one region, only 1.7% of older adults were diagnosed, while another region saw a 5.4% diagnosis rate.³ These findings suggest that geographic location alone can drastically affect whether someone receives the care they need.

Why the Southeast Shows Higher Dementia Rates

Traditionally, the Southeast is known for higher rates of Alzheimer’s and dementia diagnoses, largely because it falls within the “stroke belt“—regions where deaths from stroke are significantly higher than elsewhere in the U.S.. However, this study found that even after adjusting for health risk factors like obesity and high blood pressure, the rate of diagnosis still varies, raising questions about the quality of healthcare across the country.

Advocating for Yourself and Loved Ones

Given these discrepancies, experts encourage individuals to advocate for their own healthcare. Dr. Eseosa Ighodaro, an incoming assistant professor at Wake Forest Baptist Medical Center, recommends that patients ask their doctors about cognitive tests during annual wellness visits. If dementia is on the table, ensure all necessary tests are conducted, even if it means seeking out a specialist or a hospital better equipped to handle cognitive assessments.

Public Policy: The Key to Reducing Disparities

Addressing these geographic disparities will require significant changes in public policy and healthcare access. Bynum emphasizes that solving this issue is not a short-term task. “Training clinicians, incorporating care partners, and finding new ways to meet the needs of our aging population are essential steps,” she said. Until systemic changes are made, the onus falls on patients and their families to navigate these challenges proactively.

ZIP Codes and Healthcare Inequity

This study highlights a sobering truth: where you live can significantly impact your likelihood of receiving a timely dementia diagnosis. As dementia rates continue to rise, ensuring equal access to diagnosis and care across all ZIP codes is crucial. The path forward will require concerted efforts from both healthcare providers and policymakers to address these disparities and ensure that everyone, regardless of location, receives the care they deserve.

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