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Peer-reviewedCC BY-NC 4.0Journal of Alzheimer's Disease

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

  • Xiaoping Lin1
  • Mohammad Amin Honardoost1
  • Susannah Ahern1
  • Colman Taylor2,3,4
  • Stephanie Ward1,5,6
  • Elisabeth de Laguiche7
  • Elizabeth Adesanya8
  • Henry Brodaty5
  • Jonathan Pearson-Stuttard8
  • Sara Holloway8
  • Michael Woodward9
9 affiliations
  1. 1School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  2. 2Health Technology Analysts, Surry Hills, New South Wales, Australia
  3. 3Faculty of Medicine, UNSW, Sydney, New South Wales, Australia
  4. 4Critical Care Division, The George Institute for Global Health, Barangaroo, New South Wales, Australia
  5. 5Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia
  6. 6Department of Geriatric Medicine, The Prince of Wales Hospital, Randwick, New South Wales, Australia
  7. 7Sustainability Insights, Novo Nordisk A/S, Søborg, Denmark
  8. 8LCP Health, Lane Clark & Peacock LLP, London, UK
  9. 9Medical Health and Cognitive Research Unit, Austin Health, Heidelberg Repatriation Hospital, Victoria, Australia
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Abstract

Background: Access to high-quality and timely dementia diagnoses varies between rural and urban location.

Objective: We 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.

Methods: 3648 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.

Results: Participants 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).

Conclusions: Findings 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.

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Cite

BibTeXRIS
BibTeX
@article{lin2026ruralurban,
  title = {{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}},
  author = {Xiaoping Lin and Mohammad Amin Honardoost and Susannah Ahern and Colman Taylor and Stephanie Ward and Elisabeth de Laguiche and Elizabeth Adesanya and Henry Brodaty and Jonathan Pearson-Stuttard and Sara Holloway and Michael Woodward},
  journal = {Journal of Alzheimer's Disease},
  year = {2026},
  month = sep,
  doi = {10.1177/13872877261489828},
  url = {https://doi.org/10.1177/13872877261489828},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - 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
AU  - Xiaoping Lin
AU  - Mohammad Amin Honardoost
AU  - Susannah Ahern
AU  - Colman Taylor
AU  - Stephanie Ward
AU  - Elisabeth de Laguiche
AU  - Elizabeth Adesanya
AU  - Henry Brodaty
AU  - Jonathan Pearson-Stuttard
AU  - Sara Holloway
AU  - Michael Woodward
PY  - 2026
DA  - 2026/09/29
JO  - Journal of Alzheimer's Disease
DO  - 10.1177/13872877261489828
UR  - https://doi.org/10.1177/13872877261489828
AB  - Background: Access to high-quality and timely dementia diagnoses varies between rural and urban location.  Objective: We 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.  Methods: 3648 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.  Results: Participants 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).  Conclusions: Findings 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.
SN  - 1387-2877
SN  - 1875-8908
ER  -