Determine if the Area Deprivation Index (ADI) influences the evaluation and likelihood of receiving an etiological diagnosis of dementia in Virginia

Inequities in diagnosis and management of dementias disproportionally affect historically marginalized populations. The ADI provides a multidimensional metric of disadvantage by incorporating measures on education, housing, employment, and poverty.

We obtained UVA Health Center Electronic Medical Record data of all patients, diagnosed for the first time with dementia (2018-2021). These diagnoses were categorized as either “general” (e.g., dementia non-specified) or “disease-specific” (e.g., Alzheimer’s disease), based on the ICD-10 code used. We defined “adequate evaluation” as CT or MRI scan and vitamin B12+TSH levels. We divided the 2019 ADI into tertiles, with ~4,600 patients/tertile. A logistic regression was performed in R, adjusting for patient demographics, census tract population density, and patient address as a spatial effect.

ADI had an opposite effect on evaluation and disease-specific diagnoses. Those in more disadvantaged neighborhoods were more likely to receive an adequate evaluation, but less likely to receive a disease-specific diagnosis.This finding may explain the lower rates of recruitment of historically marginalized populations into clinical trials.