Association between Alzheimer\u27s disease and Rural Northeast Tennessee Region between 2013 and 2015

Background: Alzheimer’s disease (AD) is a type of Dementia and a neurodegenerative disease that is characterized by the gradual degrading of both memory and cognitive functions. According to the World Health Organization (WHO), the prevalence of AD is increasing globally. Currently, AD is the sixth leading cause of mortality in the United States. As the ageing population increases in the United States, it is possible that AD will move up the ladder in the top cause of mortality. Although the prevalence of AD in most urban parts of developed nations such as the United States is widely known, little is known about the prevalence and early diagnosis of the disease among the rural populations. According to a study by the Centers for Disease Control and Prevention (CDC), on deaths from AD between 1999 and 2014, most mortality are concentrated in the rural counties of the Appalachian region of the United States, where the mortality rate has increased by an alarming 75%. Our study focuses on the Northeast Tennessee region, which is a prominent part of the Appalachian region. We examine the prevalence of Alzheimer’s disease in the Northeast Tennessee region compared to other parts of the state of Tennessee. We sought to understand whether there is a likely association between the disease and the rural counties in the Northeast Tennessee region. Methods: We performed a cross-sectional study that computes and compares between the Prevalence Odds Ratio (POR) of the 2013 to 2015 Centers for Medicare and Medicaid Services Public Use Files data on rural versus urban counties in the Northeast Tennessee region followed by the Northeast Tennessee counties versus other counties in Tennessee. In addition, we collected primary data from 44 experts and professionals working in AD-related fields within the Northeast Tennessee region using an online survey that captures the perceived observation of the experts and professionals about the increasing prevalence of AD over the last five years. Results: Findings show that the rural counties within the Northeast Tennessee region had 18.3% (POR: 1.183, C.I: 1.113-1.258), 4.7% (POR: 1.047, C.I: 0.982-1.117), and 19% (POR: 1.190, C.I: 1.121-1.264) increased odds of prevalence of AD compared to the urban counties within the region in 2013, 2014, and 2015, respectively. Similarly, the Northeast Tennessee region as a whole, had increased odds of 22.7% (POR: 1.227, C.I: 1.203-1.250), 22.5% (POR: 1.225, C.I: 1.202-1.249), and 21.2% (POR: 1.212, C.I: 1.189-1.235) of AD compared to all other counties in Tennessee during the same periods. Conclusions: Statistical analysis and findings from experts and professionals working with patients with AD in the Northeast Tennessee region show that there are more cases of AD in the Northeast Tennessee region compared to the last five years. We suggest early screening strategies for possible decrease in the morbidity and mortality rates in Northeast Tennessee region