Journal Article

DZNE-2025-01365

http://join2-wiki.gsi.de/foswiki/pub/Main/Artwork/join2_logo100x88.png Regional disparities of antidementia drug treatment in Germany: what can we learn for the new generation of Alzheimer's therapies.

Platen, M. (First author)DZNE* ; Gläser, E.DZNE* ; Dahling, V. ; Gesell, D. ; Hauptmann, M. ; Horenkamp-Sonntag, D. ; Koller, D. ; Kubat, D. ; Marschall, U. ; Riederer, C. ; Scheibner, H. ; Schroth, J. ; Swart, E. ; Michalowsky, B. (Last author)DZNE*

2025
BioMed Central London

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Please use a persistent id in citations: doi:10.1186/s13195-025-01902-8

Abstract: 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.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.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.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.DRKS00031944.

Keyword(s): Humans (MeSH) ; Germany: epidemiology (MeSH) ; Alzheimer Disease: drug therapy (MeSH) ; Alzheimer Disease: epidemiology (MeSH) ; Male (MeSH) ; Female (MeSH) ; Aged (MeSH) ; Healthcare Disparities: statistics & numerical data (MeSH) ; Aged, 80 and over (MeSH) ; Rural Population (MeSH) ; Nootropic Agents: therapeutic use (MeSH) ; Socioeconomic Factors (MeSH) ; Middle Aged (MeSH) ; Alzheimer’s disease ; Antidementia drug treatment ; Deprivation ; Disease-modifying treatments, geographical variation, spatial analysis ; Healthcare disparities ; Real-world data ; Real-world evidence ; Rural population ; Nootropic Agents

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Contributing Institute(s):

1. Patient-Reported Outcomes and Health Economics Research (AG Michalowsky)

Research Program(s):

1. 353 - Clinical and Health Care Research (POF4-353) (POF4-353)

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Database coverage:
; ; Article Processing Charges ; Clarivate Analytics Master Journal List ; Current Contents - Clinical Medicine ; DOAJ Seal ; Ebsco Academic Search ; Essential Science Indicators ; Fees ; IF >= 5 ; JCR ; SCOPUS ; Science Citation Index Expanded ; Web of Science Core Collection

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