Rural-urban disparities in the clinical diagnostic pathway of patients with all-cause mild cognitive impairment and dementia due to Alzheimer's disease in Australia

BackgroundAccess to high-quality and timely dementia diagnoses varies between rural and urban location.ObjectiveWe examined rural-urban disparities in key indicators for high-quality and timely diagnoses of mild cognitive impairment (MCI) and Alzheimer's disease (AD) dementia in Australia.Methods3648 patients with all-cause MCI or AD dementia were geographically classified into major cities (75.7%), inner (15.8%) and outer (8.4%) regional areas. We used regression analyses to assess rural-urban disparities in completion of key diagnostic investigations and diagnostic wait times.ResultsParticipants in inner regional areas were more likely (odds ratio [OR] = 1.55; 95% confidence interval [CI] = 1.14, 2.13; p = 0.006) to have had more basic diagnostic investigations completed (including core blood tests, cognitive assessments, functional assessments, structural neuroimaging) compared to those in major cities. However, participants in inner regional (OR = 0.37; 95% CI = 0.28, 0.48; p < 0.001) and outer regional (OR = 0.32; 95% CI = 0.21, 0.48; p < 0.001) areas were less likely to have functional neuroimaging completed. Median wait times for an initial appointment following referral to a memory clinic were up to 28 days longer for rural compared to urban participants (Inner regional: Beta (median) = 12.91; 95% CI = 5.15, 20.69; p = 0.001; Outer regional: Beta (median) = 27.50; 95% CI = 18.80, 36.20; p < 0.001), whereas median wait times from initial appointment to diagnosis were up to 47 days shorter in rural compared to urban residents (Inner regional: Beta (median) = -46.83; 95% CI = -52.35, -41.32; p < 0.001; Outer regional: Beta (median) = -44.42; 95% CI = -50.35, -38.49; p < 0.001).ConclusionsFindings suggest disparities in access to advanced diagnostic investigations and timely initial appointments in rural Australia, and increased need for enhanced workforce and diagnostic infrastructure in these areas.