Socioeconomic and geographic inequalities in hospital-level ADRD burden: implications for hospital-to-home transitions and dementia care coordination

Alzheimer's disease and related dementias (ADRD) create challenges for hospital-to-home transitions, caregiver preparation, and home health care coordination. This cross-sectional study examined socioeconomic and geographic inequalities in hospital-level ADRD burden among 3,027 U.S. hospitals serving Medicare fee-for-service beneficiaries. Multivariable quasibinomial regression assessed associations between ADRD prevalence and hospital characteristics, rurality, census region, and patient composition. An age-adjusted sensitivity analysis was conducted among 3,003 hospitals with complete age-composition data. Mean hospital-level ADRD prevalence was 22.00% among patients and 24.00% among events. In the primary model, ADRD prevalence was higher in hospitals in the South and among hospitals serving higher proportions of dual-eligible, female, and White patients. In the age-adjusted sensitivity model, dual eligibility remained strongly associated with ADRD prevalence, while the female-composition association was attenuated. These hospital-level patterns may help identify settings where enhanced discharge planning and home health care coordination should be considered.