Racial, Socioeconomic, and Rural Disparities in Alzheimer’s Disease Burden: Implications for Home Health Care Delivery

Background: Alzheimer’s disease and related dementias (ADRD) represent a growing public health challenge in the United States, with substantial disparities across populations and health systems. However, hospital-level disparities in ADRD burden remain poorly understood, particularly in the Southern United States. This study aimed to examine racial, socioeconomic, and rural–urban disparities in hospital-level ADRD burden across hospitals in the Southern United States. Methods: This study conducted a cross-sectional analysis of 1396 hospitals across 17 Southern states. ADRD burden was defined as the proportion of patients diagnosed with ADRD at the hospital level. Racial composition, socioeconomic status (dual eligibility), and rural–urban classification were examined. Quartile-based analyses and multivariable linear regression models were used to assess disparities. Results: The mean ADRD burden was 0.24 (SD = 0.11). ADRD burden increased markedly across quartiles of both black patient composition and dual eligibility (both P < .001), with hospitals in the highest quartiles exhibiting nearly double the burden compared to those in the lowest. Rural hospitals had higher ADRD burden than metropolitan hospitals, with micropolitan hospitals showing intermediate levels. In adjusted models, higher proportions of black patients (β = .33, 95% CI 0.292-0.366; P < .001) and dual-eligible patients (β = .32, 95% CI 0.284-0.360; P < .001) were strongly associated with increased ADRD burden. These findings were consistent across analytic approaches. Conclusion: Substantial and consistent racial, socioeconomic, and rural disparities in ADRD burden exist across hospitals in the Southern United States. These findings have implications for home health care planning and community-based dementia services.