Access to hospitals for people with Alzheimer's disease and related dementias

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. In this study, we investigate the relationship between ADRD density and accessibility to hospitals. We identify underserved and overserved areas in Maryland based on diagnosed cases and mortality due to ADRD, focusing on geographic disparities in care. 2023 Maryland ADRD patients were identified using ICD-10 codes. Accessibility was measured using the Kernel Density Two-Step Floating Catchment Area (KD2SFCA) method and sensitivity analysis. The Gini index and Mann-Whitney U 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. 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 parts of the southeastern Maryland, higher-poverty areas are surrounded by zones with lower accessibility and higher health risk indices. Hospital accessibility is unevenly distributed, creating major rural disparities. Underserved regions in terms of access to hospitals, particularly in eastern and southern Maryland, exhibit high ADRD mortality rates despite low diagnosis rates. The observed discrepancy supports the hypothesis that a significant portion of the ADRD population in these regions may remain undiagnosed within the inpatient system or face barriers to timely care. • Unequal hospital access highly impacts vulnerable rural areas. • Hot spots in east/south MD exhibit significant clustered high mortality per diagnosis. • Cold spots in central MD show reduced ADRD mortality per diagnosed case. • Poverty in East MD correlates with a higher health risk and reduced accessibility.