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BackgroundThe early onset of Alzheimer's disease and related dementias (ADRD) before age 65 can introduce life and health care complications. Preserving an early-onset ADRD patient's daily functioning longer and delaying declines in health from non-ADRD conditions become important preventive goals. This study examined the differences in utilization of preventive cancer screenings between patients with and without early-onset ADRD, and compared utilization of the screenings in rural versus urban areas among women with early-onset ADRD in the United States.MethodsWe conducted a cross-sectional study of women aged 40 to 64 years eligible for mammogram and cervical cancer screenings using commercial insurance claims from 2012 to 2018. We measured the use of biennial mammogram among women 50 to 64 years old, and the use of triennial Pap smear test among women 40 to 64 years old. We used inverse probability weighted logistic regressions to estimate the odds of receiving preventive cancer screenings by the presence of early-onset ADRD or cognitive impairments (CI). We used multivariable logistic regressions to estimate the odds of receiving preventive cancer screenings by rural or urban residence among women with early-onset ADRD/CI.ResultsAmong 6,349,308 women in the breast cancer screening sample (mean [SD] age, 56.52 [4.03] years), 36,131 had early-onset ADRD/CI (mean [SD] age, 57.99 [3.98] years). Among 6,583,088 women in the cervical cancer screening sample (mean [SD] age, 52.37 [6.81] years), 30,919 had early-onset ADRD/CI (mean [SD] age, 55.79 [6.22] years). Having early-onset ADRD/CI was associated with lower utilization of mammogram (OR: 0.92, 95% CI: 0.90-0.95). No significant difference was observed in Pap smear screening (OR: 0.99, 95% CI: 0.96-1.02) between patients with and without early-onset ADRD/CI. Among patients with early-onset ADRD/CI, those in rural areas were less likely than those in urban areas to have mammograms (OR: 0.91, 95% CI: 0.85-0.97) and Pap smears (OR: 0.65, 95% CI: 0.61-0.71).ConclusionsThe observed pattern of rural-urban differences in cancer screening in our study emphasizes the need for efforts to promote evidence-based, individualized decision-making processes in the early-onset ADRD population.

Objective: To examine rural–urban disparities in substance use disorder treatment access and continuation. Data Sources and Study Setting: We analyzed a 2016–2018 U.S. national secondary dataset of commercial insurance claims. Study Design: This cross‐sectional study examined individuals with a new episode of opioid, alcohol, or other drug use disorders. Treatment initiation and engagement rates, and rates of using out‐of‐network providers for these services, were compared between rural and urban patients. Data Collection: We included individuals 18–64 years old with continuous employer‐sponsored insurance. Principal Findings: Patients in rural settings experienced lower treatment initiation rates for alcohol (36.6% vs. 38.0%, p < 0.001), opioid (41.2% vs. 44.2%, p < 0.001), and other drug (37.7% vs. 40.1%, p < 0.001) use disorders, relative to those in urban areas. Similarly, rural patients had lower treatment engagement rates for alcohol (15.1% vs. 17.3%, p < 0.001), opioid (21.0% vs. 22.6%, p < 0.001), and other drug (15.5% vs. 17.5%, p < 0.001) use disorders. Rural patients had higher out‐of‐network rates for treatment initiation for other drug use disorders (20.4% vs. 17.2%, p < 0.001), and for treatment engagement for alcohol (27.6% vs. 25.2%, p = 0.006) and other drug (36.1% vs. 31.1%, p < 0.001) use disorders. Conclusions: These findings indicate that individuals with substance use disorders in rural areas have lower rates of initial and ongoing treatment, and are more likely to seek care out‐of‐network. [ABSTRACT FROM AUTHOR]

Objectives: The question of what providers one has access to under their insurance coverage is crucial for patients in managed care. This study sought to examine information displayed in online provider directories and whether this information matched consumer preferences., Study Design: A national survey (N = 4007) paired with an analysis of online provider network directories., Methods: We conducted a quantitative content analysis of online provider directories from March 1 to May 30, 2023. A national survey of American adults was fielded from June 30 to July 2, 2023, to gauge preferences for information displayed in provider directories. Preferences and perceived importance of information elements that should be displayed in provider directories were contrasted with the data elements displayed in directories., Results: We found that provider directories showed wide variations with regard to information displayed and in the amount of navigation required by patients. There were widespread instances of disconnect between patient preferences and data availability. Important data items related to care access and provider quality that were preferred by consumers were not universally presented in directories, such as availability of telemedicine (23% presented), information about office hours (58%), and disability access (59%). Approximately 7% of directories did not indicate whether a provider was accepting new patients, despite the requirement under the No Surprises Act to display such information. Further, certain marginalized populations may find it especially challenging to acquire information about providers., Conclusions: Lack of attention to usability in provider directories may hinder the national goal of ensuring care accessibility for all.