Rural Health Research Center S outh C arolina Greater Rurality Increases Barriers to Primary Health...
-
Upload
hilary-mckinney -
Category
Documents
-
view
216 -
download
0
Transcript of Rural Health Research Center S outh C arolina Greater Rurality Increases Barriers to Primary Health...
Rural Health Research Center
South Carolina
Greater Rurality Increases Barriers to Primary Health Care: Evidence of a Gradient in Access or Quality
Janice C. Probst, PhD
James N. Laditka, PhD
Sarah B. Laditka, PhD
Arnold School of Public Health
University of South Carolina
Rural Health Research Center
South Carolina
Problematic access to primary care
Demand Rural residents more likely to be
uninsured, underinsured Rural residents face greater travel
burdens than their urban peers Supply:
Ratios decline as communities become more rural and remote
Rural Health Research Center
South Carolina
Rural residents may have worse outcomes Physician / population ratios are lower in
rural than in urban areas Higher death rates for children, young
adults, working age adults Later stage at cancer diagnosis Higher hospitalization rates for ambulatory
care sensitive conditions (ACSC)
Rural Health Research Center
South Carolina
Study questions
To ascertain the effects of rurality on ACSC hospitalization rates
To identify county-level factors associated with ACSC hospitalization rates
Rural Health Research Center
South Carolina
Methods
Cross Sectional Analysis Data source: 2002 State Inpatient Database, Area
Resource File,Census
Population: 580 counties across CO, FL, KY, MI, NY, NC, SC, & WA.
Rural Health Research Center
South Carolina
Definitions
ACS diagnoses use AHRQ definitions Rurality was defined using Urban
Influence Codes. Exclusions:
Counties with very small age‑specific populations,
Small rural counties (13) immediately adjacent to metropolitan areas.
Rural Health Research Center
South Carolina
Analysis
Separate analyses for children, working age adults, and older adults (65+)
Poisson regression Supply side control factors (county level):
Physician supply Hospital bed supply Number ED’s ED visit rates
HMO penetration Presence of a
community health center or rural health clinic
Rural Health Research Center
South Carolina
Analysis, continued
Demand side controls (county level): Estimated uninsured population (children, working
age adults only) Race/ethnicity (proportion black, Hispanic, Asian, or
American Indian, measured separately) Population change between 1990 and 2000 Percent residents with high school + education Population density Unemployment rate Death rates for several relevant chronic conditions
Rural Health Research Center
South Carolina
Unadjusted admission rates, kids
3.74 4.164.79
5.36 4.94
6.875.73
012345678
Metrolarge(76)
Metro,small(153)
Rural,adj
large(19)
Ruralmicro(117)
Rural,adj
smallmetro(95)
Rural,adj
micro(47)
Ruralremote
(53)
Rural Health Research Center
South Carolina
Unadjusted admission rates, ages 18 - 64
7.98 8.2510.10
11.28 12.23 12.6614.27
02468
10121416
Metrolarge(76)
Metro,small(152)
Rural,adj
large(19)
Ruralmicro(118)
Rural,adj
smallmetro(95)
Rural,adj
micro(48)
Ruralremote
(53)
Rural Health Research Center
South Carolina
Unadjusted admission rates, 65+
67.45 64.3971.70 77.35
83.81 87.6594.43
0102030405060708090
100
Metrolarge(75)
Metro,small(154)
Rural,adj
large(19)
Ruralmicro(117)
Rural,adj
smallmetro(94)
Rural,adj
micro(47)
Ruralremote
(51)
Rural Health Research Center
South Carolina
Adjusted rate ratios, age 18 - 64
0.7800.729
0.8800.816 0.827
0.729
0.0
0.2
0.4
0.6
0.8
1.0
Metrolarge
Metro,small
Rural,adj
large
Ruralmicro
Rural,adj
smallmetro
Rural,adj
micro
Ruralremote
p<.001p<.1
p<.001p<.001
(nsd)p<.01
p<.001(nsd) p<.001
p<.1
p<.001
Rural Health Research Center
South Carolina
Adjusted rate ratios, age 65+
0.67 0.660.75 0.75
0.81 0.84
0.00.10.20.30.40.50.60.70.80.91.0
Metrolarge
Metro,small
Rural,adj
large
Ruralmicro
Rural,adj
smallmetro
Rural,adj
micro
Ruralremote
p<.001nsd
p<.001p <.001
p<.001nsd
p<.001p<.001
p<.001p<.05
p>.001
Rural Health Research Center
South Carolina
Conclusions
Among adults:
Increasing degrees of rurality were generally associated with higher ACSC rates,
The most rural areas were at greatest risk.
Geographic differences in ACSC rates were not attributable to physician supply, county rates of health insurance coverage, education levels, or similar factors, as these were held constant in the analysis.
Rural Health Research Center
South Carolina
Conclusions
We speculate that travel impedance, poorer quality of ambulatory care in rural communities, or lack of outpatient supportive services that could substitute for inpatient care contribute to higher ACSC rates in the most rural areas.
Policies are needed to enhance health care access in rural areas.