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Health Place. 2018 Nov;54:132-137. doi: 10.1016/j.healthplace.2018.09.003. Epub 2018 Sep 25.

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

Author information

1
Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia; Menzies Centre for Health Policy, University of Sydney, Sydney, New South Wales, Australia; School of Public Health, Peking Union Medical College and the Chinese Academy of Medical Sciences, Beijing, China. Electronic address: thomasab@uow.edu.au.
2
Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia; Menzies Centre for Health Policy, University of Sydney, Sydney, New South Wales, Australia.

Abstract

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

KEYWORDS:

Alzheimer's disease; Disadvantage; Environmental epidemiology: longitudinal studies; Remoteness

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