Rural-Urban Differences in Hospitalization Rates of Primary Care Patients With Depression

Abstract

Individuals with depression in rural areas showed greater odds of hospitalization over one year than their urban counterparts in a single-state study; however, differences disappeared in models controlling for recent outpatient specialty care. To investigate whether these results are generalizable to a broader geographic area, the research team analyzed an 11-state database to test whether rural primary care patients with depression had greater odds of hospitalization over two years for physical and emotional problems, compared with their urban counterparts. Hypotheses were tested by conducting a preplanned secondary analysis of data for 1,455 patients with depression in the Quality Improvement for Depression (QID) database. This database was developed in a two-year cooperative trial that evaluated quality initiatives to improve primary care depression treatment. QID studies, including Partners in Care and Quality Enhancement by Strategic Teaming, recruited patients from rural and urban areas. Multivariate analyses demonstrated that compared with their urban counterparts, rural patients with depression had significantly higher odds of being hospitalized for physical problems (13% versus 7%, OR=1.8, 95% confidence interval [CI]=1.2-2.8, p<.01 at six months) and for emotional problems (4% versus 2%, OR=2.3, CI=1.0-5.4, p=.05 at 18 months). Hospitalization differences were not reduced in models controlling for outpatient specialty care in the previous six months. Although national studies report that all-cause hospitalization rates are comparable for rural and urban populations, rural patients with depression in this 11-site study had greater odds of hospitalization for both physical and emotional problems over two years, compared with their urban counterparts, suggesting that the potential for reducing hospitalization rates among rural patients with depression should be addressed by depression care management programs serving this population.