Differences in treatment for Alzheimer's disease between urban and rural areas in China

Abstract

IntroductionIn China, the increasing number of people with Alzheimer's disease (AD) poses a great challenge to families and the country. Economic and cultural differences cause a urban-rural gap in medical resources. This multicenter survey aimed to investigate the real-world practice of disease treatment among people with AD.MethodsPeople with AD and their caregivers from 30 provincial regions in mainland China were enrolled from October 2020 to December 2020 to be surveyed for their treatment experience. Logistic regression was used to explore the factors that influence medication adherence in all areas, urban areas, and rural areas.ResultsIn this survey, 1,427 participants came from urban areas, and 539 participants came from rural areas. Patients in urban areas were older (mean age 74 vs. 70, p = 0.001), less frequently had mild AD (36.0 vs. 52.1%, p < 0.001), and more often were cared for at professional institutions (8.8 vs. 3.2%, p < 0.001). In terms of pharmacotherapy, 77.8% of people accepted taking lifelong medication, whereas 61.3% of patients insisted on taking medications. Although 72.0% of rural people believed in taking lifelong medication, only 30.0% adhered to drug use. The major factors that influenced medication adherence for all patients with AD were regional distribution (p < 0.001, OR = 6.18, 95% CI: 4.93–7.74) and family earnings (p = 0.003, OR = 1.22, 95% CI: 1.07–1.38). In rural areas, family earnings (p = 0.008, OR = 1.44, 95% CI: 1.10–1.89) and severity of AD (p = 0.033, OR = 1.31, 95% CI: 1.02–1.68) were the main factors. Family earnings (p = 0.038, OR = 1.16, 95% CI: 1.01–1.34) was the only factor among urban areas. Among all non-pharmaceutical activities except for cognitive intervention, the participation rates of rural patients were significantly higher than those of urban patients (p < 0.05).ConclusionAlthough national progress has been made in the public awareness of disease treatment, adequate diagnosis and medication adherence need to be prompted, especially in rural areas. Furthermore, lifelong treatment should be improved based on regional characteristics through the joint efforts of the government, health workers, and social volunteers.

Cognitive aging in rural communities: preliminary memory characterization of a community cohort from Southern Nevada

“…Though this would not explain the memory advantage we found, it could potentially contribute to an accelerated rate of decline for older adults in a rural community once disease becomes clinically manifest and explain the greater magnitude of impairment in the rural cohort. If this is the case, this also may contribute to the higher mortality rates that have been reported (Weden et al, 2018;Rahman et al, 2021;Liu et al, 2022). Taken together, our findings suggest that late-life rural residence in this geographical region is not necessarily associated with an increased burden of memory impairment when compared cross sectionally and leaves open the possibility that late-life rural living may be protective for some individuals, especially those who intentionally choose to live in a rural community.…”

“…Older adults living in rural areas are thought to face significantly greater risk for Alzheimer's disease and related dementias (AD/RD) (Weden et al, 2018;Rahman et al, 2021;Liu et al, 2022) and worse clinical outcomes than those living in urban communities (Abner et al, 2016;Weden et al, 2018;Rahman et al, 2020;Cato et al, 2022). Despite these geographic health disparities, rural individuals are underrepresented in aging research, and a comprehensive understanding of the factors contributing to urbanrural disparities in AD/RD remains unclear.…”

Mental states in caregivers toward people with Alzheimer’s disease at different stages

“…More caregivers showed positive states in rural areas, which might be attributed to the patients in rural areas who more frequently participate in nonpharmaceutical therapy. As the previous article described, these nonpharmaceutical activities, including physical activity, mental activity (e.g., chess, mahjong), and musical therapy, were demonstrated to be beneficial for the improvement of cognition and neuropsychiatric symptoms ( 24 ). On the other hand, caregivers could receive support from health workers and have time for respite during the patients’ participation in nonpharmaceutical treatment.…”

“…The process of this large-sample, multicenter, cross-sectional survey has been previously described ( 24 ). Participants from 30 provincial, municipal, and autonomous regions in mainland China were enrolled between October 2020 and December 2020.…”

“…The assessments of demographic and clinical characteristics of people with AD were introduced previously ( 24 ), including gender, age, length of education, residential area, form of care, family earnings, and severity of AD. The severity of AD was estimated by neurologists based on patients’ symptoms and neuroimaging data according to the MTA criterion, which ranks the degree of hippocampal atrophy ( 27 ).…”