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Background <p>Current antidementia drugs can temporarily slow cognitive decline in Alzheimer’s disease but are underused. Regional and socioeconomic disparities, including limited specialist access in rural or deprived areas, may exacerbate inequities and challenge the rollout of emerging disease-modifying therapies. This study aimed to evaluate associations between regional contextual factors and antidementia drug prescription (AD-Rx) among newly diagnosed people living with Alzheimer’s disease (PlwAD) in Germany and to identify spatial clustering of prescribing patterns.</p> Methods <p>This study analyzed anonymized claims data from three statutory health insurers for 53,753 PlwAD who received their first diagnosis between January 2020 and December 2022. Regions, defined by three-digit postal codes (ZIP3, <i>n</i> = 576), were categorized by the German Index of Socioeconomic Deprivation (GISD) quintiles and Degree of Urbanization (urban, suburban, rural). Multilevel logistic regression with random intercepts for ZIP3 was used to assess associations between receiving AD-Rx (dichotomous) and urbanization and deprivation, adjusting for age, sex, the Charlson Comorbidity Index, the long-term care level and the year of diagnosis. Global Moran’s I was used to evaluate large-scale spatial clustering, and regional Moran’s I was calculated to detect regional hotspots and coldspots.</p> Results <p>Overall, 64% of PlwAD received at least one AD-Rx. Rural residency was associated with slightly lower odds of receiving AD-Rx compared to urban areas (OR 0.92; 95%CI 0.87–0.98; <i>p</i> = 0.010), whereas deprivation was not. Interaction models demonstrated that an increased deprivation further reduced AD-Rx odds in rural areas (OR per GISD unit = 0.98; 95% CI 0.96–0.99; <i>p</i> = 0.024). Global Moran’s I revealed no significant large-scale clustering (I = 0.011; <i>p</i> = 0.613), but regional analysis identified several regional hotspots (high-high clusters) predominantly in moderately deprived urban areas and coldspots (low-low clusters) in highly deprived or rural areas.</p> Conclusion <p>Alzheimer’s patients in rural and high-deprivation regions face limited access to recommended antidementia medications. Targeted interventions, such as teleconsultations, expanding specialist outreach, and collaborative care models in underserved areas, as well as regional dementia networks and national registries, could promote the equitable delivery of current and future Alzheimer’s antibody therapies. However, further qualitative and quantitative research is needed to identify the underlying regional causes of these treatment disparities.</p> Trial registration <p>DRKS00031944.</p>

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Regional disparities of antidementia drug treatment in Germany: what can we learn for the new generation of Alzheimer’s therapies

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月4日

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  • Moritz Platen,
  • Eva Gläser,
  • Volker Dahling,
  • Daniela Gesell,
  • Michael Hauptmann,
  • Dirk Horenkamp-Sonntag,
  • Daniela Koller,
  • Denise Kubat,
  • Ursula Marschall,
  • Cordula Riederer,
  • Hannah Scheibner,
  • Jennifer Schroth,
  • Enno Swart,
  • Bernhard Michalowsky

摘要

Background

Current antidementia drugs can temporarily slow cognitive decline in Alzheimer’s disease but are underused. Regional and socioeconomic disparities, including limited specialist access in rural or deprived areas, may exacerbate inequities and challenge the rollout of emerging disease-modifying therapies. This study aimed to evaluate associations between regional contextual factors and antidementia drug prescription (AD-Rx) among newly diagnosed people living with Alzheimer’s disease (PlwAD) in Germany and to identify spatial clustering of prescribing patterns.

Methods

This study analyzed anonymized claims data from three statutory health insurers for 53,753 PlwAD who received their first diagnosis between January 2020 and December 2022. Regions, defined by three-digit postal codes (ZIP3, n = 576), were categorized by the German Index of Socioeconomic Deprivation (GISD) quintiles and Degree of Urbanization (urban, suburban, rural). Multilevel logistic regression with random intercepts for ZIP3 was used to assess associations between receiving AD-Rx (dichotomous) and urbanization and deprivation, adjusting for age, sex, the Charlson Comorbidity Index, the long-term care level and the year of diagnosis. Global Moran’s I was used to evaluate large-scale spatial clustering, and regional Moran’s I was calculated to detect regional hotspots and coldspots.

Results

Overall, 64% of PlwAD received at least one AD-Rx. Rural residency was associated with slightly lower odds of receiving AD-Rx compared to urban areas (OR 0.92; 95%CI 0.87–0.98; p = 0.010), whereas deprivation was not. Interaction models demonstrated that an increased deprivation further reduced AD-Rx odds in rural areas (OR per GISD unit = 0.98; 95% CI 0.96–0.99; p = 0.024). Global Moran’s I revealed no significant large-scale clustering (I = 0.011; p = 0.613), but regional analysis identified several regional hotspots (high-high clusters) predominantly in moderately deprived urban areas and coldspots (low-low clusters) in highly deprived or rural areas.

Conclusion

Alzheimer’s patients in rural and high-deprivation regions face limited access to recommended antidementia medications. Targeted interventions, such as teleconsultations, expanding specialist outreach, and collaborative care models in underserved areas, as well as regional dementia networks and national registries, could promote the equitable delivery of current and future Alzheimer’s antibody therapies. However, further qualitative and quantitative research is needed to identify the underlying regional causes of these treatment disparities.

Trial registration

DRKS00031944.