Study Reveals How Your ZIP Code Could Influence a Dementia Diagnosis

Opine This: You and your sister are 66-year-old twins, both on Medicare, with a family history of Alzheimer’s disease. Early diagnosis is crucial for your long-term planning and preventive care. Given that Medicare offers cognitive screening during annual wellness visits, you assume that it would be made if one of you needed a diagnosis.

Now, consider this scenario: You live in Hartford, Connecticut, while your sister is just 26 miles away in Springfield, Massachusetts. Despite your proximity, a new study reveals that you’re 18% more likely to receive a dementia diagnosis in Hartford than she is in Springfield.

This discrepancy, according to Medicare data, might be due to differences in how the healthcare systems in Connecticut and Massachusetts handle screenings and referrals for Alzheimer’s and related dementias. Lead study author Julie Bynum, a professor of internal medicine and geriatric and palliative medicine at the University of Michigan Medical School, points out that such disparities are common across the U.S. In fact, depending on your ZIP code, you could be twice as likely to receive a dementia diagnosis in some regions compared to others.

The study found that people living in areas with the lowest diagnostic intensity—meaning doctors there are less likely to offer tests and treatments—are 28% less likely to receive a timely diagnosis. Conversely, those in regions with the highest diagnostic intensity, where physicians are more proactive, are 36% more likely to be diagnosed with Alzheimer’s or another form of dementia.

Bynum explains that differences in healthcare behaviors and systems, independent of patient risk levels, contribute to this variability. Without a diagnosis, patients miss out on crucial education, preparation, and access to new treatments.

Although Bynum had access to ZIP code-specific data, privacy restrictions prevented her from publishing them. However, a map created from the study offers a visual representation of the disparities in timely dementia diagnoses across different states and regions.

The study emphasizes the unjust reality that patients receive varying levels of care based on their location, a concern echoed by Dr. Eseosa Ighodaro, an incoming assistant professor of neurology at Atrium Health Wake Forest Baptist Medical Center. She stresses the urgency of addressing these disparities, especially given the availability of new medications for Alzheimer’s that have emerged since 2021.

An early diagnosis not only opens the door to treatments but also allows for participation in clinical trials, specialized care, and improved quality of life, according to Lycia Neumann, senior director of health services research for the Alzheimer’s Association.

Bynum’s research also challenges the traditional view that the Southeast, known as the “stroke belt,” has the highest rates of Alzheimer’s diagnoses. Her team’s analysis of Medicare claims data across 306 hospital referral regions in the U.S. revealed that diagnostic intensity varies widely, and the emphasis is not solely on the Southeast.

Regions like Alaska, Connecticut, and the Texas Panhandle showed strong alignment between expected and actual dementia diagnoses. Surprisingly, Florida, with its older Medicare population, did not.

The largest discrepancies were found among the youngest age group (66 to 74), where early intervention could be most beneficial, and among Black and Hispanic populations, who are at higher risk for dementia.

Bynum notes that even within the Black community, there are significant differences in diagnosis rates depending on ZIP code, highlighting that the issue is not just about group characteristics but also about regional healthcare practices.

Insurance coverage, stigma, and overworked physicians further complicate the picture. Even within the Medicare system, access to diagnostic tests varies, and cognitive decline carries a stigma that may deter both doctors and patients from pursuing a diagnosis.

For those concerned about cognitive decline, Ighodaro advises being proactive. Contact doctors in advance to ensure cognitive assessments are part of annual wellness visits, and verify insurance coverage for any necessary tests. Early detection is key, as it may determine eligibility for new medications that could significantly improve quality of life.

Ultimately, Bynum and other experts stress the importance of addressing these healthcare disparities to ensure that everyone, regardless of where they live, has access to timely and accurate dementia diagnoses.