Rural Groups Research Articles

Linking the Community Health Fund with Accredited Drug Dispensing Outlets in Tanzania: exploring potentials, pitfalls, and modalities

BackgroundIn low- and middle-income countries, too, public–private partnerships in health insurance schemes are crucial for improving access to health services. Problems in the public supply chain of medicines often lead to medicine stock-outs which then negatively influence enrolment in and satisfaction with health insurance schemes. To address this challenge, the government of Tanzania embarked on a redesign of the Community Health Fund (CHF) and established a Prime Vendor System (Jazia PVS). Informal and rural population groups, however, rely heavily on another public–private partnership, the Accredited Drug Dispensing Outlets (ADDOs). This study takes up this public demand and explores the potentials, pitfalls, and modalities for linking the improved CHF (iCHF) with ADDOs.MethodsThis was a qualitative exploratory study employing different methods of data collection: in-depth interviews, focus group discussions, and document reviews.ResultsStudy participants saw a great potential for linking ADDOs with iCHF, following continuous community complaints about medicine stock-out challenges at public health facilities, a situation that also affects the healthcare staff’s working environment. The Jazia PVS was said to have improved the situation of medicine availability at public health facilities, although not fully measuring up to the challenge. Study participants thought linking ADDOs with the iCHF would not only improve access to medicine but also increase member enrolment in the scheme. The main pitfalls that may threaten this linkage include the high price of medicines at ADDOs that cannot be accommodated within the iCHF payment model and inadequate digital skills relevant for communication between iCHF and ADDOs. Participants recommended linking ADDOs with the iCHF by piloting the connection with a few ADDOs meeting the selected criteria, while applying similar modalities for linking private retail outlets with the National Health Insurance Fund (NHIF).ConclusionsAs the government of Tanzania is moving toward the Single National Health Insurance Fund, there is a great opportunity to link the iCHF with ADDOs, building on established connections between the NHIF and ADDOs and the lessons learnt from the Jazia PVS. This study provides insights into the relevance of expanding public–private partnership in health insurance schemes in low- and middle-income countries.

How Does the Heterogeneity of Family Structure Affect the Area of Land Transferred Out in the Context of Rural Revitalization?—Experience from CHIP 2013

Using the sample data of rural households in China’s income survey (CHIP 2013), this paper divides the family structure into elite and incomplete families and analyzes the impact of family structure’s heterogeneity on land transferred out. The Tobit and Ordinary Least Squares (OLS) models are applied to achieve the study’s objectives. The results show that the elite family has a significant positive impact on the paid land subcontract area, while the incomplete family is not significant. After further refining the elite families, it is found that the influence of the families with the political status of Party members (non-grassroots cadres) on the land transfer area is more significant, while the influence of the families with the status of grassroots cadres on the land transfer area is less significant. Then, the formation mechanism of the difference between these two is discussed, which may be explained by the heterogeneity of their endowment structure, functions, and livelihood attributes. After a series of robustness tests, the results still show that elite families significantly positively impact the area of land transferred out. Finally, based on the differences in land transfer areas and the consequences of different resource endowments, the corresponding countermeasures and suggestions are put forward from the aspects of strengthening grassroots governance, legal awareness, and establishing and improving the protection mechanism of vulnerable rural groups.

A Nationwide Study of Residual Fate of Fluxapyroxad and Its Metabolites in Peanut Crops Across China: Assessment of Human Exposure Potential.

Elaborating on the residual fate of fluxapyroxad and its metabolites based on their nationwide application was vital to protect the human population from their hazardous effects. In this study, a rapid and sensitive analytical method was developed to trace fluxapyroxad and two of its metabolites in peanut matrices using an ultrahigh chromatography method coupled with mass spectrometry (UHPLC−MS/MS) within 3.5 min. The occurrence, pharmacokinetic degradation and terminal magnitudes of fluxapyroxad were reflected in the original deposition of 8.41−38.15 mg/kg, half−lives of 2.5−8.6 d and final concentrations of 0.004−37.38 mg/kg in peanut straw. The total concentrations of fluxapyroxad in peanut straw (0.04−39.28 mg/kg) were significantly higher than those in peanut kernels (<0.001−0.005 mg/kg) and an obvious concentration effect was observed in fresh (0.01−11.56 mg/kg) compared dried peanut straw (0.04−38.97 mg/kg). Fluxapyroxad was demethylated to 3−(difluoromethyl)−N−(3′,4′,5′−trifluoro[1,1′−biphenyl]−2−yl)−1H−pyrazole−4−carboxamide (M700F008, 0.02−5.69 mg/kg) and further N−glycosylated to 3−(difluoromethyl)−1−(ß−D−glucopyranosyl)−N−(3′,4′,5′−triflurobipheny−2−yl)−1H−pyrzaole−4−carboxamide (M700F048, 0.04−39.28 mg/kg).The risk quotients of the total fluxapyroxad for the urban groups were significantly higher than those for the rural groups, and were both negatively correlated with the age of the groups, although both acute (ARfD%, 0.006−0.012%) and chronic (ADI%, 0.415−1.289%) risks are acceptable for the human population. The high-potential health risks of fluxapyroxad should be continuously emphasized for susceptible toddlers (1−3 years), especially those residing in urban areas.

Generation Z’s Perceptions of The Malay Language in The Industrial Revolution 4.0 Era: A Sociocognitive Analysis

Industrial Revolution 4.0 (IR 4.0) which emphasizes on Science and Technology and the need to master these fields in English is seen to have an impact on the perceptions of Generation Z (Gen Z) towards Malay language. Therefore, this study aims to identify and analyse the levels of perception towards Malay language among Generation Z, who are born and grew up in this era. Data was obtained from 660 respondents through a survey conducted through Google Form. The respondents consisted of the Generation Z throughout Malaysia who received invitations based on the set criteria, including urban, suburban and rural groups. The research instrument developed specifically for this study has a high level of validity and reliability, which is ? = .75 to ? = .91. Data were analyzed descriptively and inferentially using the Statistical Package for Social Sciences (SPSS) software version 25.0. This study utilizes Sociocognitive Theory and the sociocognitive approach to describe the relationship between social background and the levels of perception of the Malay language among Gen Z. In general, this study found that only 14.0% of Gen Z have a positive perception and 13.0% have a highly positive perception of the Malay language. While 56.0% of Gen Z in this study had a negative perception and 17.0% had a highly negative perception of the Malay language.

GEROFIT TO HOME: REDUCING BARRIERS TO GROUP EXERCISE TO RURAL AND NONRURAL OLDER ADULTS IN A SUCCESSFUL FASHION

Abstract Transportation, scheduling and travel distance can present as barriers to participation in facility based exercise programs. Gerofit to Home(GTH) eliminates aforementioned burdens commonly associated with in-person programs. Understanding participant satisfaction and retention in rural(R) and non-rural(NR) groups assists in planning to better serve these populations with group exercise. This study aims to explore GTH participant satisfaction and retention in over 100 participants, through 3 months, for veterans over 65yo in rural and non-rural areas. Current results illustrate “Highly Satisfied” in majority of both R and NR groups. Retention at 3 months, in both groups, and factors associated with 3-month retention will be discussed in this presentation. Further research into the reasoning for participant stoppage prior to 3 months will aide in understanding how to better cater group exercise to these groups. Satisfaction scores in this study endorse further efforts for virtual group exercise in older adults.

Urban–rural differences in outcomes and management of vertebral fractures: A real-world observational study

A fracture liaison services (FLSs) and its modified services reduce refractures and mortality and can be cost-effective. Limited studies have addressed whether urban-rural differences exist in vertebral fracture outcomes and management. Therefore, the aims of the study were to investigate any urban-rural differences in refracture, mortality, prescription pattern, and associated factors of vertebral fractures after receiving assistance from an FLSs. Baseline characteristics and osteoporosis medication prescription patterns of participants were collected. After 1-year follow-up, mortality, refracture rate, and osteoporosis medication switching and adherence were evaluated. Multivariate logistic regressions were performed to identify baseline correlates on one-year mortality. There was higher mortality rate in the rural group but no urban-rural difference in the 1-year refracture rate after implementation of FLSs and medication management services (MMSs). The types of osteoporosis medications prescribed for both groups were similar, but participants in the rural group were less likely to change their osteoporosis medications during the 1-year follow-up timeframe and with lower adherence rate. The likelihood of being older and having chronic kidney disease, osteoarthritis, and neurological disease was higher in the rural group. Our multicomponent services have similar effectiveness in osteoporosis treatment between urban and rural areas. The overall adherence rate was lower in the rural group with higher mortality but no difference in the refracture rate in one year.

Health shocks, basic medical insurance and common prosperity: Based on the analysis of rural middle-aged and elderly groups.

Health is a major part of human welfare. The index system of common prosperity was constructed for middle-aged and elderly people in rural areas. Besides, the impart of health shocks and rural basic medical insurance on common prosperity was explored. The data for this study came from China Health and Retirement Longitudinal Survey (CHARLS) in 2013, 2015, and 2018. The finding shows that health shocks hindered the improvement of the common prosperity of the middle-aged and elderly in rural areas, among which daily activities produced the greatest negative effect. The heterogeneity analysis shows that health shocks have a stronger negative effect on the common prosperity of low-income groups than that of high-income ones. The shock of daily activity ability has the greatest influence on the middle-aged and elderly between 45 and 55 years old. However, acute health shocks have a strong negative effect on those aged above 56. The mechanism analysis shows that rural basic medical insurance can alleviate the health shocks to middle-aged and elderly people, but the effect is limited. In general, low-income groups benefit more. Therefore, China should speed up the promotion of the Healthy China Strategy and the reform of the rural basic medical insurance system, and prompt changes from an inclusive to a targeted policy to provide more precise safeguards for vulnerable groups.

Understanding regional disparities in healthcare quality and accessibility in West Bengal, India: A multivariate analysis

AbstractHealthcare inequality is a major issue in developing countries, as it puts increasing pressure on the local population, particularly rural and disadvantaged groups, to maintain a decent standard of living and have equitable access to healthcare. Using principal component analysis and average aggregation methods, a multilevel, dimension‐based composite healthcare quality index was constructed in the present study. The healthcare quality and accessibility index has four aspects (availability, affordability, accommodation, and amenities) with 21 parameters. The four‐dimensional index and healthcare quality and accessibility index were used to map the spatial pattern of healthcare disparity in the context of service availability, distribution of healthcare facilities, and socioeconomic status across the 18 districts of West Bengal, India. The findings show that in West Bengal, different districts have the widest discrepancies in the various dimensions considered for this research, which require particular attention. According to the healthcare quality and accessibility index, districts in the state's northern and western regions are underdeveloped, which corresponds to a wide variance in total healthcare service quality, accessibility, and socioeconomic position. Puruliya, Maldah, Uttar Dinajpur, Dakshin Dinajpur, Jalpaiguri, and Coochbehar are the districts with the lowest healthcare quality and accessibility, accounting for 28.63% of the total area and housing 17.96 million people who suffer greatly from the poor access to decent healthcare.

Tuberculosis in Larynx

Introduction: Laryngeal tuberculosis (TB) has shown increase in incidence in recent years and the increase in immunosuppressive conditions has altered the clinical profile of the disease. The aim of this study was to evaluate the changing trends of laryngeal TB and to highlight its site of involvement, type of lesion, and degree of involvement. Patients and Methods: This prospective study included 54 patients with a diagnosis of laryngeal TB. All patients were evaluated in terms of their age, chief complaints, lesions, and site of involvement on flexible fiber-optic bronchoscopy, and they also underwent a variety of laboratory investigations as indicated. Results: The study showed that true vocal cords + false cords + epiglottis were involved in 48.1% (n = 26), arytenoids + interarytenoid + posterior part of true cords in 24.1% (n = 13), true cords + false cords + arytenoids + interarytenoid in 18.5% (n = 10), true vocal cords alone in 5.5% (n = 3), interarytenoid in 1.8% (n = 1), and interarytenoid + arytenoid involvement was seen in 1.8% (n = 1) of patients. These lesions were categorized into four different appearances as follows: granulomatous lesions in 50% (n = 27), ulcerative lesions in 27.7% (n = 15), hyperemia and hypertrophic in 16.7% (n = 9), and papillomatous mass in 5.6% (n = 3) based on fiber-optic bronchoscopy. Conclusion: In this study, the disease was most rampant in the age group of 31–60 years, with a predilection seen in low socioeconomic groups, rural groups and in individuals addicted to smoling and alcoholism. Hoarseness and odynophagia are the major symptoms. Multiple subsites are involved, and the lesions show a predilection for the anterior part of the vocal cord.

Equality between diversities: accessibility through territorial analysis

Diversity and inclusion refer to removing physical, psychological, and frequently even digital barriers in order to make websites easier to use. Through the creation of new digital systems well suited for a high degree of comprehension and accessible from the physical point of view, a place must be useful from the cognitive point of view of the mind in order to be accessible without too many obstacles. The case under consideration suggests the investigation of a region with important historical significance through the development of a digital archive with a view to valorization. The present attention for the city of Giugliano in Campania has been on the breakdown of rural cultural groupings that could instead serve as recollections of a distant past filled with traditions and history. It is vital to photographically and technologically recreate such rural areas that serve as excellent witnesses of customs and culture to establish a digital repository of documented memory that everyone may easily access despite diversity. This contribution takes a look not only at what steps need to be taken in the area of diversity and inclusion, but also at the century-old debate that opposes science and theology. The dialogue between these two very contemporary issues can and must coexist through the relationship and union of new technologies and the inclusion of all members of the community in broad social and cultural spheres.

Applying the polio model to New Zealand: The contingent role of socioeconomic status in infectious disease mortality

AbstractObjectivesThe traditional polio model depicts a positive relationship between the disease and socioeconomic status (SES), with higher SES associated with exposure to the poliovirus beyond infancy/early childhood and a higher mortality rate. This study uses occupation data from non‐Māori New Zealand death registrations and the Census to assess evidence for differential mortality by SES during the polio epidemics of 1916, 1924–25, and 1936–37.Materials and MethodsPolio deaths were classified by father's occupation using the Caversham Project scheme, which includes nine collapsible urban occupational strata and codes rural occupations separately. Evidence for differential mortality and differences in age at death between rural and urban areas and among urban occupational strata was assessed using nonparametric Mann–Whitney U, Kruskal–Wallis, Jonckheere‐Terpstra, and chi‐square tests.ResultsThere was limited evidence of either differential mortality or differences in age at death among collapsed urban strata, mainly in 1924/25, only partially meeting the expectations of the traditional polio model. For 1916 only, the rural group had a higher proportion of deaths (χ2 (1, n = 95) = 8.341, p = 0.0039, φ = 0.30)) and higher age at death (U = 828.00, p = 0.026, r = −0.23).DiscussionThese results suggest that rural New Zealand was more isolated from poliovirus infection prior to 1916, but thereafter rural and urban groups faced more similar exposure patterns and mortality—at least among non‐Māori. The degree to which occupational categories reflect conditions of exposure requires further research.

Evaluation of rural-urban patterns in dietary intake: A descriptive analytical study - Case series.

This article aimed to evaluate the different epidemiological aspects of the population (Fez-Meknes region), expose the secular trends of the food habits related to it, present the basic concepts and mechanisms of food in urban and rural areas in the Fez-Meknes region, and finally to analyze the results in the light of a literature review. A survey was conducted among a representative sample of the urban and rural population in the Fez-Meknes region (654 people aged 15 years and over, of which 326 people reside in the urban commune of Fez and 328 in the rural commune of Loulja in the province of Taounate). The results are, a difference between the two urban and rural groups concerning the rhythm of taking meals outside the home (P<0,001); the average frequency of consumption of certain foods according to social class (p<0,001); the frequency of food consumption per week of legumes, olive oil, fermented milk, and tea is more increased than that recorded in the urban environment (p<0,001). On the other hand, the quantification of the consumption of sweet products, dairy products, and whole grains did not conclude a significant difference between the two study environments (p>0,05). Changing dietary patterns over the past few decades, including more shift work, more meals eaten outside the home or family setting, and more irregular eating patterns, including skipping breakfast and eating late at night. A disparity in eating habits between urban and rural areas was noted. It would be necessary to act judiciously on the environmental factors by encouraging the Moroccan populations to maintain, as much as possible, their good traditional habits, and to reinforce the new good food habits.

The nexus between households’ indebtedness and consumption: the role of gender, geographical area and income groups

PurposeThe persistent increase in household indebtedness is an alarming issue that is becoming a major concern for economists and governments in developing nations. Although household consumption is an essential source of economic growth, households’ failure to meet their financial obligations will be one of the causes of economic problems if the increase in consumption is largely financed by household borrowing. Therefore, this study aims to analyse the nexus between households’ indebtedness and consumption and the roles of household characteristics.Design/methodology/approachThis study uses a microdata set of the Household Expenditure and Income Survey in 2019, which contained a simple random sampling of 4,730 households.FindingsUsing a simultaneous equations model, our results show a negative nexus between households’ consumption and their indebtedness. We find that household savings and size have an indirect impact on the debt service ratio, while the assets and total debt repayment instalments indirectly influence household consumption. We also identify differences in the relationship between the gender of the household head, rural and urban locations and income groups in consumption and indebtedness.Research limitations/implicationsThe implication of this study is that governments should adopt several programmes to increase the awareness of household financial and debt management, especially for those in the low-income group.Originality/valueThis study contributes to the empirical literature by establishing a microeconomic perspective of consumption and an indebtedness model focusing on the differences in household characteristics in explaining consumption and indebtedness.

How to Realize the Integration of Urbanization and Rural Village Renewal Strategies in Rural Areas: The Case Study of Laizhou, China

To promote the coordinated development of urban and rural areas, China has adopted a hybrid strategy of urbanization and rural village renewal. Due to the large development differences between villages, choosing appropriate strategies is significant for rural development. By introducing a new idea to promote urban–rural integration development through a “rural cluster”, this paper explores the comparative advantages of villages in urbanization and renewal, identifies the spatial interaction between villages, and proposes a rural cluster strategy based on the same characteristics and close relationships. Taking Laizhou city, a coastal county in eastern China, as the study area, it provides a new way to deal with village problems at a small scale but of a large number due to difficult development in China. The results indicated that some villages have both high or low rural urbanization suitability (RUS) and village renewal potential (VRP), which makes it difficult to choose development strategies. Compared with the VRP, the spatial interaction of villages in the RUS is closer, but fewer villages participated. The results of village clustering show that the scale of different village clusters and the degree of interaction between villages in Laizhou differ greatly, and village clusters across townships are very common. Since the driving forces of the different scale of rural groups vary, this paper suggests that the development direction and investment focus should be determined according to the scale and characteristics of individual rural groups.

Digital literacy and subjective happiness of low-income groups: Evidence from rural China.

Improvements of the happiness of the rural population are an essential sign of the effectiveness of relative poverty governance. In the context of today's digital economy, assessing the relationship between digital literacy and the subjective happiness of rural low-income groups is of great practicality. Based on data from China Family Panel Studies, the effect of digital literacy on the subjective well-being of rural low-income groups was empirically tested. A significant happiness effect of digital literacy on rural low-income groups was found. Digital literacy promotes the subjective happiness of rural low-income groups through income increase and consumption growth effects. The observed happiness effect is heterogeneous among different characteristic groups, and digital literacy significantly positively impacts the subjective happiness of rural low-income groups. Decomposition of subjective happiness into life satisfaction and job satisfaction shows that digital literacy significantly positively affects the job and life satisfaction of rural low-income groups. This paper demonstrates that digital literacy induces a practical happiness effect. To further strengthen the subjective welfare effect of digital literacy in the construction of digital villages, the government should focus on cultivating digital literacy among low-income groups from the demand side. The construction of digital infrastructure should be actively promoted from the supply side.

Everyday resilience: Rural communities as agents of change in peatland social-ecological systems

The ability to maintain livelihoods in the face of major environmental, political, economic and social stresses is fundamental to building resilient social and ecological communities. This research examines the place community has in this challenge and specifically the role of community involvement in the conservation of peatland social-ecological systems. It explores transformative change at local levels and the relational networks, diverse economies and range of resources communities draw on to achieve this change. Evidence is drawn from a survey, interviews and three case studies of rural community groups in the Irish midlands to provide an overview of local dynamics in peatland conservation and wider issues of place-based development and adaptation. Drawing on theoretical insights from resilience, resourcefulness and diverse economies scholarship, this research reveals the role of local communities in both adapting to, and enacting, change through everyday forms of resilience that are commonplace and ubiquitous in people's lives yet often invisible and under-valued. Thematic areas are identified which provide insights into how communities are: engaging in diverse work practices that foster ecological livelihoods and planetary well-being; co-creating community science projects through local networks and multi-level partnerships; and developing management and stewardship cultures that emphasise collaboration, co-operation and the commons. This research will help actors at a variety of scales to plan and implement more collaborative and inclusive research and restoration programs for peatland conservation. It also has relevance for regions with landscapes in transition that seek to initiate equitable community capacity-building programs and diverse economies in the shift from extractive to regenerative land use. These transitions will require investment and resources both for ecosystem restoration and the relational networks that are so crucial to the work of building the collaborative communities, cultures and economies of the future.

Investigation and Research on the Current Situation and Development Path of Community Group Buying in Rural Areas from the Perspective of "Rural Revitalization" Strategy

In February 2021, the "National Rural Revitalization Bureau" was officially launched, which indicates that the fight against poverty has won a comprehensive victory, and the comprehensive implementation of "rural revitalization" has become the general focus of the "three rural" work in the new era. With the development of the rural community group buying mode, it has also become a new way to help, benefit and rejuvenate agriculture under the background of "rural revitalization". Many places sell farmers' own products through community group buying platforms to achieve poverty alleviation and rural revitalization. With the overall promotion and development of "rural revitalization", the rural consumer market is changing rapidly. Nowadays, community group buying in many first tier and second tier cities has become increasingly competitive with the help of capital. In contrast, most rural areas are still in the initial stage. In combination with the consumption habits of rural residents, consumption pain points and the demand of production side and demand side connection, we found that the rural community group buying has a high degree of fit with the rural consumer market. With the market sinking and the introduction of a series of inclusive policies, the promotion and use of community group buying in rural areas will receive more help. Rural community group buying is becoming a new direction and new force to revitalize rural development. It has broad prospects and is worth looking forward to. In this regard, this paper starts with the investigation and research on the current situation and development path of group buying in rural communities of Bengbu City, collects relevant data, visits the cooperative points of group buying in rural communities, effectively combines various analysis methods such as statistics and machine learning, deeply discusses the development of group buying in rural communities under the perspective of the "rural revitalization" strategy, and analyzes the adaptability of the rural consumer market of group buying in rural communities. Dialyze the development of the industry, insight into the future trend, put forward strategic suggestions for the healthy development of the rural community group buying market, promote the development of the industry, drive economic growth, and benefit the people's livelihood.

"Digital Dividend" or "Digital Divide": What Role Does the Internet Play in the Health Inequalities among Chinese Residents?

With the vigorous development of the medical industry in China, residents' health has been significantly improved. However, along with the income gap, urban-rural gap, and healthcare resource gap caused by economic development, health inequality has become a fundamental barrier to the promotion of residents' health. The popularity of the Internet has helped close the gap to some extent, but it also has drawbacks. Using data from the China Family Panel Studies (CFPS) from 2014 to 2018, we evaluated the effects of Internet usage on health disparities among residents using fixed effect models, mediation effect models, and other methodologies. The findings indicate that Internet usage can help to minimize health inequality since it lowers income inequality, promotes health consciousness, and reduces depression. Furthermore, Internet usage plays a greater role on the health improvement of the middle-aged, the elderly, urban residents, and females. Although the Internet has brought "digital dividends" in general, the Internet usage rates among different groups also reveal that there is a clear "digital gap" among rural residents, elderly groups, and low-income groups. These results have significant implications for promoting healthcare equality.

Change and Continuity in Preventive Practices Across the COVID-19 Pandemic Among Rural and Urban Latinx Immigrant Worker Families.

(1)The COVID-19 pandemic has put essential workers at high risk for contracting the disease. This study documents situational compliance with public health recommendations such as masking and social distancing among rural and urban Latinx families, with the goal of understanding change over time in COVID-19 risk reduction behaviors. (2)Respondents for 67 rural families and 44 urban families responded to repeated telephone surveys at three time points in the first year of the pandemic, providing data on use of masks and social distancing by themselves and family members while interacting with others at home, work, and in the community. Cumulative logistic regression models were employed to compare changes in risk behaviors between rural and urban groups over time. (3)While group descriptive results indicated behaviors that posed low risk at each time point, regression models revealed greater change between time points for rural than urban residents. Rural residents also had gendered patterns. (4)Patterns of change appear to reflect structural issues such as seasonal labor demand and gender roles more than pandemic fatigue or changing public health recommendations. The findings suggest that structural factors play a role in individuals complying with public health prevention measures for COVID-19.

The role of geographic disparities in outcomes after orthopaedic trauma surgery

IntroductionHealthcare disparities linked to patient rurality and socioeconomic status are known to exist, but few studies have examined the effect of urban versus rural status on outcomes after orthopedic trauma surgery. The aim of this study was to examine the correlation between patient rurality, socioeconomic status, and outcomes after orthopedic trauma. Materials and methodsThis is a retrospective cohort study of patients diagnosed with a hip or long bone fracture between January 2016 and December 2017. Data were collected from the Nationwide Inpatient Sample (NIS), a 20% weighted sample of 95% of the U.S. inpatient population. Patients were stratified into 3 groups: isolated hip fracture, isolated long bone fracture, and polytrauma. Bivariate analysis was completed using chi-squared tests for categorical variables and t-tests for continuous variables. Multivariable analysis was completed using population-weighted logistic regression models, based on a conceptual model derived selection of covariates. ResultsWe included 235,393 patients diagnosed with a hip or extremity fracture. These were weighted to represent 1,176,965 patients nationally. In the hip fracture group, rural patient status was associated with higher odds of mortality (OR 1.32, P < 0.001) but not complications (OR 0.95, P = 0.082). In the extremity fracture and polytrauma groups, rural patient status was not associated with significantly higher odds of mortality or complications. In the urban polytrauma group, zip code with below-median income was associated with increased odds of mortality (OR 1.23, P = 0.002) but not complications. In the rural polytrauma group, zip code with below-median income was not associated with significantly increased odds of mortality or complications. In the hip fracture and extremity fracture groups, below-median income was not associated with significantly higher odds of mortality. ConclusionWe found that rural patients with hip fracture have higher mortality compared to urban patients and that socioeconomic disparities in mortality after a polytrauma exist in urban settings. These results speak to the ongoing need to develop objective measures of disparity-sensitive healthcare and optimize trauma systems to better serve low-income patients and patients in rural areas.