Abstract
OBJECTIVES: To determine the nationwide prevalence of dementia as it intersects with rurality for Aboriginal and Torres Strait Islander and non-Indigenous peoples in Australia. STUDY DESIGN: Cross-sectional population-based prevalence study using nationwide respondent-reported data. SETTING, PARTICIPANTS: All people aged 45 years and older, including people living in residential aged care facilities, hospitals and prisons, who responded to the 2021 Australian census. MAIN OUTCOME MEASURES: Crude, age-specific and age-standardised dementia prevalence, and odds of dementia, for Aboriginal and Torres Strait Islander and non-Indigenous peoples across remoteness levels. RESULTS: For non-Indigenous peoples, the crude and age-standardised (World Health Organization standard) prevalence of dementia was 10.6 and 7.4 per 1000 persons, respectively. For Aboriginal and Torres Strait Islander peoples, the crude and age-standardised prevalence was 13.4 and 16.2 per 1000 persons, respectively. The age-specific prevalence ratio for Aboriginal and Torres Strait Islander and non-Indigenous peoples was most pronounced at younger age bands (3.5 for 45-49 years, 3.8 for 50-54 years and 3.4 for 60-64 years), narrowing to 1.6 among those aged 80-84 years. Odds of dementia decreased significantly with increasing remoteness for non-Indigenous peoples, but not for the Aboriginal and Torres Strait Islander population. Increasing age and no educational attainment were strongly associated with increased odds of dementia across both populations. CONCLUSIONS: Consideration of geography is of crucial significance in dementia epidemiology, particularly for Aboriginal and Torres Strait Islander peoples. Our findings confirm those of previous community cohort and linked data studies that highlight the disproportionate burden of dementia borne by Aboriginal and Torres Strait Islander peoples using a national dataset. Place should inform targeted health care policy to address risk and protective factors for dementia prevention and care.