Is the risk of developing Alzheimer\u27s disease really higher in rural areas? A multilevel longitudinal study of 261,669 Australians aged 45 years and older tracked over 11 years

Cross-sectional studies of Alzheimer\u27s disease tend to report higher risk in \u27rural\u27 areas. Multilevel longitudinal analysis of 261,669 participants in the Sax Institute\u27s 45 and Up Study was conducted, tracking incidence of Alzheimer\u27s disease defined by the first cholinesterase inhibitor prescription via linked records from the Department of Human Services in Australia. Alzheimer\u27s disease was diagnosed in 3046 participants over 11 years. Adjusting for age, gender, education, income and area disadvantage, Alzheimer\u27s disease risk was lower in \u27outer regional and remote areas\u27 (incident rate ratio 0.81, 95%CI 0.67-0.97) compared with \u27major cities\u27. Further research on environmental factors is warranted