Which health care problem is more common in rural areas compared to urban areas?
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In the U.S., rural residents have poorer health than urban residents and this disadvantage is growing. Therefore, it is important to understand rural–urban differences in access to medical care. This study compared the percentage of individuals with a usual source of care and characteristics of usual source of care providers across 3 urban–rural categories. Show
MethodsThis study identified 51,920 adults from the 2014–2016 Medical Expenditure Panel Survey and estimated the percentage with a usual source of care across the rural–urban categories. Then, differences in a variety of provider characteristics were examined. Estimates were weighted to be representative of the U.S. non-institutionalized population and adjusted for age, race/ethnicity, self-rated health, and presence of chronic conditions. Analysis was conducted in 2018 and 2019. ResultsCompared with metropolitan county residents, residents of the most rural counties were 7 percentage points more likely to have a usual source of care (81% vs 74%), but their providers were 13 percentage points less likely to be physicians (22% vs 35%). Despite having to travel longer to reach their usual source of care providers, residents of the most rural counties were 18 percentage points less likely than metropolitan residents to have usual source of care providers with office hours on nights and weekends (27% vs 39%). ConclusionsRural–urban differences in access to care are complex; there is a rural disadvantage on some dimensions of access but not others. To understand rural–urban disparities in healthcare access, research should move beyond the usual source of care provider as an overall indicator and instead investigate disparities using multiple indicators of access based on theoretically distinct domains. Section snippetsINTRODUCTIONResidents of rural areas in the U.S. are, on average, less healthy than urban residents, and the health gap is widening.1,2 Perhaps as a consequence, it is often assumed that rural areas lag behind urban areas with respect to access to and quality of health care. Yet, the literature on rural–urban disparities in access to care is mixed, depending in part on the examined indicators of access.3, 4, 5, 6 In particular, the percentage of people who have a usual source of care (USC) provider, a Study PopulationData on adults aged ≥18 years were obtained from the Medical Expenditure Panel Survey (MEPS), a stratified and clustered random sample of the U.S. non-institutionalized population based on the preceding year's sample from the National Health Interview Survey.14, 15, 16 Information on healthcare access, quality, use, and expenditures is collected by the MEPS in 5 interview rounds.17,18 To increase sample size, annual person-level files were pooled to form 1 large cross-sectional sample covering RESULTSConsistent with previous studies, the results showed that the proportion of people with a USC provider was higher, not lower, in nonmetro areas compared with metro areas (Table 1). Although this ostensibly pointed to an advantage in access for nonmetro residents, the characteristics of USC providers varied substantially between metro and nonmetro areas. Compared with metro residents, a lower proportion of nonmetro residents identified an individual as a USC provider, but instead could identify DISCUSSIONThis study extends previous research by examining rural–urban differences across 3 dimensions of access not examined previously: accessibility, accommodation, and acceptability of care. These dimensions encompass not only whether individuals have USC providers, but the types of providers they have, the characteristics of providers and their practices, and perceptions of patient–provider communication. Consistent with previous research, results show that residents of nonmetro areas were more CONCLUSIONSThe health gap between rural and urban areas is large and growing, and improving access to primary medical care is one possible way to address the problem. To do so requires a better understanding of rural–urban disparities in ambulatory care access. This study documents rural–urban differences in 3 dimensions of access and shows that the pattern of differences is complex: nonmetro residents are substantially disadvantaged relative to metro residents on some dimensions of access (i.e., ACKNOWLEDGMENTSThe views in this article are those of the authors and no official endorsement by the Agency for Healthcare Research and Quality or the Department of Health and Human Services is intended or should be inferred. This research was conducted as a part of the official duties of the authors; there was no outside funding. Neither author has conflicts of interest or financial disclosures to report. REFERENCES (31)
Rural‐urban differences in access to preventive health care among publicly insured MinnesotansJ Rural Health(2018) Role of geography and nurse practitioner scope-of-practice in efforts to expand primary care system capacity: health reform and the primary care workforceMed Care(2016) Full scope-of-practice regulation is associated with higher supply of nurse practitioners in rural and primary care health professional shortage countiesJ Nurs Regul(2018) The Medical Expenditure Panel. Survey: a national health information resourceInquiry(1996) Design and Methods of the Medical Expenditures Panel Survey Household Component(1997) 2021, Preventive Medicine Show abstractNavigate Down Breast cancer is the most common cancer and the second most common cause of cancer mortality among women in the United States. Efforts to promote breast cancer control in rural settings face specific challenges. Access to breast cancer screening, diagnosis, and treatment services is impaired by shortages of primary care and specialist providers, and geographic distance from medical facilities. Women in rural areas have comparable breast cancer mortality rates compared to women in urban settings, but this is due in large part to lower incidence rates and masks a substantial rural/urban disparity in breast cancer survival among women diagnosed with breast cancer. Mammography screening utilization rates are slightly lower among rural women than their urban counterparts, with a corresponding increase in late stage breast cancer. Differences in breast cancer survival persist after controlling for stage at diagnosis, largely due to disparities in access to treatment. Travel distance to treatment centers is the most substantial barrier to improved breast cancer outcomes in rural areas. While numerous interventions have been demonstrated in controlled studies to be effective in promoting treatment access and adherence, widespread dissemination in public health and clinical practice remains lacking. Efforts to improve breast cancer control in rural areas should focus on implementation strategies for improving access to breast cancer treatments. 2022, Diabetologia 2022, BMC Health Services Research 2022, Journal of Community Health 2022, Economic Development Quarterly 2022, Frontiers in Public Health Research article American Journal of Preventive Medicine, Volume 58, Issue 1, 2020, pp. 59-68 Show abstractNavigate Down Sexual minorities are disproportionately more likely than heterosexuals to suffer from substance use disorders, but relatively little is known about differences in substance use disorders across diverse sexual minority subgroups. There is also limited understanding of how different social stressors account for sexual orientation disparities in substance use disorders. Using nationally representative data collected in 2012–2013 (n=34,597), differences in past-year DSM-5 alcohol, cannabis, and tobacco use disorders were assessed across 4 sexual orientation groups (heterosexuals and 3 sexual minority subgroups, lesbian/gay-, bisexual-, and heterosexual-identified sexual minorities). This study assessed whether stressful life events mediated substance use disorder disparities between heterosexuals and each sexual minority subgroup, and whether stressful life events and lesbian, gay, and bisexual discrimination events mediated these substance use disorder differences. Analyses were conducted in 2019. For both men and women, substance use disorders and stress experiences varied by sexual identity. For example, compared with heterosexual men, larger proportions of gay and bisexual men had a past-year alcohol use disorder. Among women, all sexual minority subgroups had higher rates of each substance use disorder than heterosexuals. For each substance use disorder, stressful life events mediated disparities between heterosexuals and sexual minority subgroups, except for heterosexual-identified sexual minority men. Both stressful life events and lesbian, gay, and bisexual discrimination mediated substance use disorder differences between sexual minority subgroups, with stronger indirect effects through lesbian, gay, and bisexual discrimination for lesbians/gay men and stronger indirect effects through stressful life events for bisexual adults, generally. Sexual minority subgroups have a greater prevalence of substance use disorders, mediated through both stressful life events and lesbian, gay, and bisexual discrimination. More research is needed to comprehensively assess the processes underlying sexual orientation substance use disparities. Research article American Journal of Preventive Medicine, Volume 58, Issue 1, 2020, pp. 41-49 Show abstractNavigate Down Beginning September 3, 2014, CVS Health stopped selling tobacco products in all of its retail stores nationwide. This study assessed the impact of removing tobacco sales from CVS Health on cigarette smoking behaviors among U.S. adult smokers. CVS Health retail location data (2012–2016) were linked with data from the Behavioral Risk Factor Surveillance System, a phone-based survey of the non-institutionalized civilian population aged ≥18 years. Using a difference-in-differences regression model, quit attempts and daily versus nondaily smoking were compared between smokers living in counties with CVS stores and counties without CVS stores, before and after CVS's removal of tobacco sales. Control variables included individuals’ sociodemographic and health-related variables, state tobacco control variables, and urban status of counties. Analyses were conducted in 2018. During the 2-year period following the removal of tobacco sales from CVS Health, smokers living in counties with high CVS density (≥3.5 CVS stores per 100,000 people) had a 2.21% (95% CI=0.08, 4.33) increase in their quit attempt rates compared with smokers living in counties without CVS stores. This effect was greater in urban areas (marginal effect: 3.03%, 95% CI=0.81, 5.25); however, there was no statistically significant impact in rural areas. Additionally, there was no impact on daily versus nondaily smoking in either urban or rural areas. Removing tobacco sales in retail pharmacies could help support cessation among U.S. adults who are attempting to quit smoking, particularly in urban areas. Research article American Journal of Preventive Medicine, Volume 58, Issue 1, 2020, pp. e1-e9 Show abstractNavigate Down Cancer risk and screening data are limited in their ability to inform local interventions to reduce the burden of cancer in vulnerable populations. The San Francisco Health Information National Trends Survey was developed and administered to assess the use of cancer-related information among under-represented populations in San Francisco to provide baseline data for the San Francisco Cancer Initiative. The survey instrument was developed through consultation with research and community partners and translated into 4 languages. Participants were recruited between May and September 2017 through community-based snowball sampling with quotas to ensure adequate numbers of under-represented populations. Chi-square tests and multivariate logistic regression were used between 2018 and 2019 to assess differences in screening rates across groups and factors associated with cancer screening. One thousand twenty-seven participants were recruited. Asians had lower rates of lifetime mammogram (p=0.02), Pap test (p<0.01), and prostate-specific antigen test (p=0.04) compared with non-Asians. Hispanics had higher rates of lifetime mammogram (p=0.02), lifetime Pap test (p=0.01), recent Pap test (p=0.03), and lifetime prostate-specific antigen test (p=0.04) compared with non-Hispanics. Being a female at birth was the only factor that was independently associated with cancer screening participation (AOR=3.17, 95% CI=1.40, 7.19). Screening adherence varied by race, ethnicity, and screening type. A collaborative, community-based approach led to a large, diverse sample and may serve as a model for recruiting diverse populations to add knowledge about cancer prevention preferences and behaviors. Results suggest targeted outreach efforts are needed to address disparate cancer screening behaviors within this diverse population. Research article Use of ENDS and Cigarettes During PregnancyAmerican Journal of Preventive Medicine, Volume 58, Issue 1, 2020, pp. 122-128 Show abstractNavigate Down Although the use of alternative tobacco products has been increasing among women and adolescents, research on the use of ENDS during pregnancy has been limited. This study examines the prevalence and sociodemographic characteristics of ENDS and cigarette use during pregnancy. This cross-sectional analysis of the 2016 Pregnancy Risk Assessment Monitoring System used data on self-reported use of ENDS and cigarettes during the last 3 months of pregnancy among 33,964 women from 29 states and New York City. Data were analyzed in 2019. The overall prevalence of prenatal ENDS use was 1.2% and cigarette use was 7.7%, varying from 0.6% and 1.8% in New York City to 4.4% and 22.7% in West Virginia. In adjusted models, white women were more likely to use ENDS (AOR=4.68, 95% CI=2.91, 7.54) than black women. Women with increasing years of education were also less likely to use ENDS. Women who used cigarettes during pregnancy were 11.05 times (95% CI=7.40, 16.48) more likely to also use ENDS prenatally. Associations between sociodemographic characteristics and cigarette use during pregnancy were consistent with the findings for ENDS. Pregnant women across the U.S. are using ENDS and cigarettes. Surveillance is essential to continue monitoring trends in prenatal use of tobacco products and understand the implications on pregnancy and infant outcomes. Research article Sugary Drink Consumption Among Children by Supplemental Nutrition Assistance Program StatusAmerican Journal of Preventive Medicine, Volume 58, Issue 1, 2020, pp. 69-78 Show abstractNavigate Down The Supplemental Nutrition Assistance Program is the largest U.S. federally funded nutrition assistance program, providing food assistance to more than 40 million low-income Americans, half of whom are children. This paper examines trends in sugar-sweetened beverage consumption among U.S. children and adolescents by Supplemental Nutrition Assistance Program participation status. Dietary data from 15,645 participants (aged 2–19 years) were obtained from the 2003–2014 National Health and Nutrition Examination surveys. Supplemental Nutrition Assistance Program participation was categorized as: Supplemental Nutrition Assistance Program participant, income-eligible nonparticipant, lower income–ineligible nonparticipant, and higher income–ineligible nonparticipant. Survey-weighted logistic regressions estimated predicted probabilities of daily sugar-sweetened beverage consumption, and negative binomial regressions estimated predicted per capita daily consumption of sugar-sweetened beverage calories. Data were analyzed in 2019. From 2003 to 2014, there were significant declines across all Supplemental Nutrition Assistance Program participation categories for sugar-sweetened beverage consumption (participants: 84.2% to 75.6%, p=0.009; income-eligible nonparticipants: 85.8% to 67.5%, p=0.004; lower income–ineligible nonparticipants: 84.3% to 70.6%, p=0.026; higher income–ineligible nonparticipants: 82.2% to 67.7%, p=0.001) and per capita daily sugar-sweetened beverage calories (participants: 267 to 182 kilocalories, p<0.001; income-eligible nonparticipants: 269 to 168 kilocalories, p<0.001; lower income–ineligible nonparticipants: 249 to 178 kilocalories, p=0.008; higher income–ineligible nonparticipants: 244 to 161 kilocalories, p<0.001). Per capita sports/energy drink consumption increased among Supplemental Nutrition Assistance Program participants (2 to 15 kilocalories, p=0.007). Sugar-sweetened beverage consumption has declined for children and adolescents in all Supplemental Nutrition Assistance Program participation categories, but current levels remain high. There were fewer favorable trends over time for consumption of sugar-sweetened beverage subtypes among Supplemental Nutrition Assistance Program participants relative to other participant categories. Research article Patient-Centered Medical Home and Up-To-Date on Screening for Breast and Colorectal CancerAmerican Journal of Preventive Medicine, Volume 58, Issue 1, 2020, pp. 107-116 Show abstractNavigate Down Effectiveness of the patient-centered medical home model for promoting cancer screening utilization is uncertain, with prior research showing mixed results. Using national patient–provider pair data, this study examined whether having a patient-centered medical home–certified provider influences receipt of recommended screening for breast and colorectal cancer. A cross-sectional analysis was performed in 2019 on data from the 2015–2016 Medical Organizational Survey and Medicare Expenditure Panel Survey. Participants included U.S. adults aged 50–75 years who met screening guidelines from the U.S. Preventive Services Task Force. Multivariable regression models estimated the up-to-date rates of breast cancer and colorectal cancer screening between the patient-centered medical home and non–patient-centered medical home groups. The study sample comprised 4,052 patient–provider pairs, representing a weighted 40.1 million screening-eligible individuals cared for by 2,314 practices. Of those, 1,909 (48.2%) were cared for by patient-centered medical home–certified providers. Unadjusted up-to-date rates were similar between patient-centered medical homes and non–patient-centered medical homes (breast cancer screening, 85.4% vs 83.4%; colorectal cancer screening, 73.3% vs 73.3%). Adjusted analysis indicated no significant differences in rates of breast cancer (p=0.228) or colorectal cancer screening (p=0.878). In subgroup analyses, however, having a patient-centered medical home–certified provider was associated with higher screening rates among individuals aged 50–64 years and those with a private plan for breast cancer and among other racial/ethnic minorities for colorectal cancer. Obtaining care from a patient-centered medical home–certified provider is not associated with increased breast cancer or colorectal cancer screening uptake. Findings of this study suggest that tailoring cancer screening strategies to patient mix may be needed to improve cancer screening utilization in patient-centered medical homes. Which health care problem is more common in rural areas compared to urban areas less personalized care?Obesity is a major concern for rural areas. While overweight issues often occur in rural and urban communities, children in rural areas experience higher obesity rates. Risk factors for obesity include poverty and a lack of access to healthcare, including obesity prevention and treatment services.
What diseases are more common in rural areas?Heart disease and stroke are historically more prevalent in rural areas, and rural residents have higher death rates from these diseases.
What is the most important problem related to health in urban areas?The rising noncommunicable disease burden, the persistent threat of infectious disease outbreaks and an increased risk of violence and injuries are key public health concerns in urban areas.
What are the top 3 rural health priorities?Access to health care continues to be the most frequently identified rural health priority. Within this priority, emergency services, primary care, and insurance generate the most concern. A total of 926 respondents identified access as the no.
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