Evidence map›Paper›PMID 40082869›Full record

Trial reportBMC health services research2025

Urban-rural differences in the health care of people living with dementia and mild cognitive impairment in shared-housing arrangements in Germany - have inequities in urban vs. rural locations been overcome?

Carolin Donath, Antonia Keck, Elmar Graessel, Janissa Altona, Susanne Stiefler, Julia Misonow, Serhat Guenay, Karin Wolf-Ostermann, André Kratzer

Abstract readMulticenter StudyRandomized Controlled Trial
In one paragraph

Trial report in BMC health services research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Trial
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Carolin DonathCenter for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany. carolin.donath@uk-erlangen.de.ORCID http://orcid.org/0000-0001-9502-861X
Antonia KeckCenter for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
Elmar GraesselCenter for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
Janissa AltonaInstitute for Public Health and Nursing Science (IPP), University of Bremen, Bremen, Germany.ORCID http://orcid.org/0009-0002-9357-3504
Susanne StieflerInstitute for Public Health and Nursing Science (IPP), University of Bremen, Bremen, Germany.
Julia MisonowInstitute for Public Health and Nursing Science (IPP), University of Bremen, Bremen, Germany.
Serhat GuenayCompetence Center for Clinical Trials Bremen (KKSB), University of Bremen, Bremen, Germany.
Karin Wolf-OstermannInstitute for Public Health and Nursing Science (IPP), University of Bremen, Bremen, Germany.ORCID http://orcid.org/0000-0001-8513-3125
André KratzerCenter for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.ORCID http://orcid.org/0000-0001-7906-3079

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPrevious studies have identified inequities in the diagnostic and therapeutic procedures used with community-dwelling people living with dementia (PlwDs) or people living with mild cognitive impairment (PlwMCIs) depending on the urban vs. rural location of their residence. Whether those differences in health care and health services utilization still exist for people residing in shared-housing arrangements (SHAs) remains unclear at this point.

methodsIn a prospective, multicenter, mixed-methods, cluster-randomized controlled trial, the "DemWG study," 341 PlwDs or PlwMCIs living in a total of 97 SHAs across Germany were recruited. 31 of the participating SHAs were rural (133 participants), 66 were urban (208 participants). As a secondary analysis we evaluated health care data (e.g. vaccinations, medication), utilization of inpatient/outpatient medical services, non-pharmacological therapies according to the German Remedies Directive, provision of health and medical aids and structural data of the SHAs. Variables were assessed at baseline by trained staff from the SHAs using validated instruments (e.g. FIMA - questionnaire for health-related resource use in an elderly population). Descriptive and inferential statistical methods were applied. P-values were corrected with the Benjamini-Hochberg procedure.

resultsThe majority of the assessed health care data did not show significant differences between urban and rural SHA inhabitants. After the p-values were corrected, only two variables remained different: inhabitants of rural SHAs were prescribed a significantly larger number of total drugs, while urban inhabitants had significantly more appointments with neurologists/psychiatrists in the last 6 months. There were no significant differences in the use of all other type of inpatient/outpatient services, non-pharmacological therapies, use of health and medical aids. Also, the structural data of the SHAs like staffing did not significantly differ between urban and rural place of living. DISCUSSION: While it seems that most inequities in the care of PlwDs/PlwMCIs living in SHAs between rural and urban areas have been overcome, there is still the one crucial difference in this non-representative sample of SHAs: the contact with neurologic/psychiatric specialists who offer elaborated diagnostic procedures is less frequent in rural areas.

trial registrationISRCTN89825211 (Registered prospectively, 16 July 2019).

Indexed as

Cognitive DysfunctionDementiaHealthcare DisparitiesRural PopulationUrban PopulationAgedAged, 80 and overFemaleGermanyHumansMaleProspective StudiesDementiaHealth inequitiesHealth services researchMild cognitive impairmentRural health servicesShared-housing arrangementsUrban health services

Identifiers

PMID40082869
PMCPMC11905690

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.