Journal
AMERICAN JOURNAL OF PUBLIC HEALTH
Volume 106, Issue 8, Pages 1463-1469Publisher
AMER PUBLIC HEALTH ASSOC INC
DOI: 10.2105/AJPH.2016.303212
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Funding
- Agency for Healthcare Research and Quality [R36- HS022811-01]
- California Center for Population Research [R24-HD041022]
- Section of Hospital Medicine at the University of Chicago [4T32-HS78-18]
- National Institutes of Health/National Institute on Aging [P30-AG021684]
- Centers for Disease Control and Prevention [U58DP005812]
- [1R01-N4014789-01]
- [1R21HD074446-01A1]
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Objectives. To examine whether living in a rural versus urban area differentially exposes populations to social conditions associated with disparities in access to health care. Methods. We linked Medical Expenditure Panel Survey (2005-2010) data to geographic data from the American Community Survey (2005-2009) and Area Health Resource File (2010). We categorized census tracts as rural and urban by using the Rural-Urban Commuting Area Codes. Respondent sample sizes ranged from 49 839 to 105 306. Outcomes were access to a usual source of health care, cholesterol screening, cervical screening, dental visit within recommended intervals, and health care needs met. Results. African Americans in rural areas had lower odds of cholesterol screening (odds ratio[OR] = 0.37; 95% confidence interval[CI] = 0.25,0.57) andcervical screening(OR = 0.48; 95% CI = 0.29, 0.80) than African Americans in urban areas. Whites had fewer screenings and dental visits in rural versus urban areas. There were mixed results for which racial/ethnic group had better access. Conclusions. Rural status confers additional disadvantage for most of the health care use measures, independently of poverty and health care supply.
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