% IMPORTANT: The following is UTF-8 encoded.  This means that in the presence
% of non-ASCII characters, it will not work with BibTeX 0.99 or older.
% Instead, you should use an up-to-date BibTeX implementation like “bibtex8” or
% “biber”.

@ARTICLE{Platen:282629,
      author       = {Platen, Moritz and Gläser, Eva and Dahling, Volker and
                      Gesell, Daniela and Hauptmann, Michael and
                      Horenkamp-Sonntag, Dirk and Koller, Daniela and Kubat,
                      Denise and Marschall, Ursula and Riederer, Cordula and
                      Scheibner, Hannah and Schroth, Jennifer and Swart, Enno and
                      Michalowsky, Bernhard},
      title        = {{R}egional disparities of antidementia drug treatment in
                      {G}ermany: what can we learn for the new generation of
                      {A}lzheimer's therapies.},
      journal      = {Alzheimer's research $\&$ therapy},
      volume       = {17},
      number       = {1},
      issn         = {1758-9193},
      address      = {London},
      publisher    = {BioMed Central},
      reportid     = {DZNE-2025-01365},
      pages        = {259},
      year         = {2025},
      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.},
      keywords     = {Humans / Germany: epidemiology / Alzheimer Disease: drug
                      therapy / Alzheimer Disease: epidemiology / Male / Female /
                      Aged / Healthcare Disparities: statistics $\&$ numerical
                      data / Aged, 80 and over / Rural Population / Nootropic
                      Agents: therapeutic use / Socioeconomic Factors / Middle
                      Aged / Alzheimer’s disease (Other) / Antidementia drug
                      treatment (Other) / Deprivation (Other) / Disease-modifying
                      treatments, geographical variation, spatial analysis (Other)
                      / Healthcare disparities (Other) / Real-world data (Other) /
                      Real-world evidence (Other) / Rural population (Other) /
                      Nootropic Agents (NLM Chemicals)},
      cin          = {AG Michalowsky},
      ddc          = {610},
      cid          = {I:(DE-2719)5000067},
      pnm          = {353 - Clinical and Health Care Research (POF4-353)},
      pid          = {G:(DE-HGF)POF4-353},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:41345718},
      pmc          = {pmc:PMC12696915},
      doi          = {10.1186/s13195-025-01902-8},
      url          = {https://pub.dzne.de/record/282629},
}