Rural-urban Disparities Research Articles

Urban-Rural Disparities in Food Insecurity and Weight Status among Children in the United States.

Place of residence (urban versus rural) is a contextual determinant of health that has received less attention in the food insecurity literature. The purpose of this study was to assess the urban-rural disparity in the prevalence of food insecurity and weight status among US children. Using data from the National Health and Nutrition Examination Survey (NHANES) 2013-2016 with three age groups of children (2-5, 6-11, and 12-17 years old), the associations of weight status and child and household food security status by urban-rural residence were examined using Rao-Scott Chi-square tests. Statistical significance was set at p < 0.05. Children living in urban areas were significantly more likely to experience household food insecurity (29.15%) compared to their rural counterparts (19.10%), among those aged 6-11 years. The associations between children's weight status and child and household food security status were significant for children living in urban areas overall and different age groups but not for children living in rural areas. These trends were more pronounced in older age groups. Given the link between food insecurity and higher obesity rates, particularly among urban children, this study highlights the importance of incorporating food security interventions into future obesity prevention programs.

Rural-urban disparities and socioeconomic determinants of caesarean delivery rates in Zimbabwe: Evidence from the 2019 National Multiple Indicator Cluster Survey.

Caesarean sections (CSs) have increased globally, with concerns being raised involving overutilisation and inequalities in access. In Zimbabwe, where healthcare access varies greatly, we aimed to analyse factors associated with ever having a CS using the 2019 National Multiple Indicator Cluster Survey. The weighted national CS rate was 10.3%, and CS happened more commonly among women in urban than rural areas (15.7% v. 7.4%; odds ratio (OR) 2.34; (95% confidence interval (CI)) 1.71 - 3.20; p=0.001). Percentages of those having a CS significantly increased with education: overall χ2 for a trend of p=0.001 and wealth quintile, and overall χ2 for a trend of p=0.001. Women with insurance coverage were more likely to have had a CS than those without: 26.7% v. 8.7%; OR 3.82; 95% CI 2.51 - 5.83; p=0.001. The same was the case for women with access to the internet: 15.4% v. 7.0%, OR 2.42; 95%CI 1.71 - 3.41; p=0.001). These findings show an association that could indicate this being overutilised by insured women in urban settings, rather than being accessible based on clinical needs. Further research should explore reasons for these disparities and inform interventions to ensure equitable access to optimum childbirth in Zimbabwe.

Rural-Urban Disparities in the Surgical Treatment of Carpal Tunnel Syndrome in the United States.

Rural populations are at risk for poorer access to health services and lower quality care, and recent policy efforts have focused on the reduction of rural-urban health inequities. The objective of this study was to identify differences in (1) patient demographic factors, (2) the utilization of confirmatory electrodiagnostic (EDS) testing, and (3) preoperative EDS severity between rural and urban populations undergoing carpal tunnel release (CTR). We retrospectively identified 1,297 patients who underwent CTR at a tertiary referral center from July 2008 to June 2013. Exclusion criteria were acute trauma or infection, revision surgery, incomplete medical records, neoplasm excision, and the lack of rural-urban commuting area (RUCA) code for rural-urban classification. A final cohort of 1,138 patients who underwent CTR were included. The RUCA was used to classify patients by rural or urban residence. We assessed patient demographic factors including comorbidities, the utilization of confirmatory EDS testing, and preoperative EDS severity. A bivariate screen was performed for associations between rural-urban residence and our outcome variables, and variables with p <0.05 in the bivariate screen were included in a multivariable logistic regression model. Of the 1,138 patients, 55 patients (5%) resided in a rural area and 1,083 patients (95%) resided in an urban area. No difference was found in the utilization of confirmatory EDS testing between rural and urban patients undergoing CTR. The final multivariable logistic regression model showed that rural residence was independently associated with older age, lower body mass index (BMI), and EDS-negative disease. Rural patients undergoing CTR are more likely to have EDS-negative disease, which calls into question the effectiveness of EDS testing as a confirmatory test in this population. There is a paucity of literature on the outcomes of CTR in a rural population, and further studies are needed to ensure rural-urban equity in care.

Urban–rural health disparity among patients with chronic kidney disease: a cross-sectional community-based study from 2012 to 2019

ObjectivesThe incidence of chronic kidney disease (CKD) is increasing owing to the ageing population, resulting in an increased demand for dialysis and kidney transplantation, which can be costly. Current research...

Analysis of the Ghanaian Health System and Patients Safety within the IHI Triple Aim Framework

Abstract Objective: To analyze Ghana’s healthcare system challenges through the Institute for Healthcare Improvement’s Triple Aim framework encompassing population health, patient experience and per capita cost metrics. Method: Dimensional analysis of peer-reviewed papers, government data and case studies assessed population health indicators and equity, literature on patient perspectives regarding quality and responsiveness of care along with evaluation of cost trends and deficiencies driving expenditure growth. Results: Gaps persist in universal health coverage amid rural-urban disparities in access and financial protection. Care experiences vary significantly by socioeconomic status and geography. Rising costs attributed to inefficiencies in areas like procurement and prescriber practices. Scientific Novelty: Unique application of Triple Aim framework for structured health systems analysis in a lower-middle income sub-Saharan country enabling robust diagnosis of coverage, quality, sustainability gaps. Practical Significance: Demonstrates utility of balanced Triple Aim methodology for health policymakers in low-resource settings to systematically evaluate healthcare priorities across access, outcomes, experiences and costs.

Role of Digital Financial Literacy for Mobile Banking Adoption in Digital Era

Western Odisha, like many other regions in the country, is currently experiencing significant growth in both financial services and smartphone ownership. This accelerate development highlights the increasing importance of digital financial literacy in influencing the adoption and utilization of mobile banking services. The purpose of this study is to investigate how digital financial literacy impacts the use of mobile banking in Western Odisha. To understand the complex relationship between digital financial literacy and mobile banking behavior, a multifaceted approach was taken, including in-depth interviews. A total of 400 samples were collected from four districts in Western Odisha (Bargarh, Bolangir, Boudh, Kalahandi). The findings of the study reveal the intricate connections between financial literacy, digital literacy, digital financial literacy, and mobile banking behavior. It is crucial to address issues such as the rising rate of cybercrimes, the needs of senior citizens, and urban-rural disparities in terms of network coverage and technical infrastructure to promote equal access to mobile banking services. By addressing these challenges, we can fully leverage the potential of digital financial technologies for economic empowerment. Key words- digital financial literacy, mobile banking adoption. digital literacy

Bibliometric Analysis of Urban and Rural Economic Inequality

This bibliometric study provides a comprehensive analysis of the scholarly landscape surrounding research on economic inequality, utilizing VOSviewer to visualize the thematic clusterization, temporal trends, emerging research opportunities, and collaborative networks in the field. The analysis begins with the identification of key thematic areas, revealing a complex interplay between income inequality, urban-rural disparities, and their socioeconomic impacts. A temporal examination traces the evolution of research themes from foundational studies focusing on regional disparities to more comprehensive explorations of socioeconomic outcomes. Emerging research opportunities are identified in less explored areas, suggesting potential for significant contributions through novel investigations. Furthermore, the study delves into collaborative networks, highlighting the pivotal roles of central researchers and the impact of academic partnerships. This study not only maps out the current academic terrain but also proposes strategic directions for future research, aiming to enhance the understanding and resolution of economic inequalities.

Social gradient and rural-urban disparities in cancer mortality in Costa Rica

IntroductionData on social inequalities in cancer mortality are sparse, especially in low- and middle-income countries. We aimed to analyze the socioeconomic inequalities in cancer mortality in Costa Rica between 2010 and 2018. MethodsWe linked 9-years of data from the National Electoral Rolls, National Birth Index and National Death Index to classify deaths due to cancer and socioeconomic characteristics of the district of residence, as measured by levels of urbanicity and wealth. We analyzed the fifteen most frequent cancer sites in Costa Rica among the 2.7 million inhabitants aged 20 years and older. We used a parametric survival model based on a Gompertz distribution. ResultsCompared to urban areas, mixed and rural area residents had lower mortality from pancreas, lung, breast, prostate, kidney, and bladder cancers, and higher mortality from stomach cancer. Mortality from stomach, lung and cervical cancer was higher, and mortality from colorectal cancer, non-Hodgkin lymphoma and leukemia was lower in the most disadvantaged districts, compared to the wealthiest ones. ConclusionWe observed marked disparities in cancer mortality in Costa Rica in particular from infection- and lifestyle- related cancers. There are important opportunities to reduce disparities in cancer mortality by targeting cancer prevention, early detection and opportune treatment, mainly in urban and disadvantaged districts.

Place of residence and blood sugar testing practices among men: insights from the 2021 Madagascar demographic and health survey

BackgroundIn 2021, Madagascar had approximately 13,919 people living with diabetes, with 66.1% of cases being undiagnosed. The implication is that this population are at high risk of developing diabetes complications which will affect their quality of life. However, promoting the uptake of screening practices such as the blood glucose test among the asymptomatic population would offer a chance to reduce the prevalence of undiagnosed diabetes in the country. This study examined the association between place of residence and blood sugar testing practices among men in Madagascar.MethodsSecondary data from the men recode file of the 2021 Madagascar Demographic and Health Survey (MDHS) was used. A sample of 9,035 were used for the analysis. Descriptive and multivariate analyses were performed in STATA version 14. The results are presented in adjusted odds ratio (AOR) with the corresponding 95% confidence interval.ResultsOnly 5.83% reported to have ever had their blood glucose/sugar tested by a health professional. Residing in rural areas was associated in lower likelihood of undergoing a test to check one’s blood sugar level [AOR = 0.23; 95%CI = 0.19–0.28] compared to those in urban areas. This association remained consistent even after adjusting for the effects of covariates [AOR = 0.67; 95%CI = 0.52–0.86].ConclusionWe conclude that place of residence plays a significant role in influencing men’s decision to test their blood glucose level. It is, therefore, imperative for the Madagascar Public Health Department to liaise with the government to bridge the rural-urban disparities in terms of accessibility to blood glucose testing services. Practically, this can be achieved by instituting community-based health services centers in the rural areas of Madagascar to mitigate the rural-urban disparities. Also, health education campaigns to raise men’s awareness about the need to test their blood glucose level must necessarily target older men, those without formal education, those without health insurance, and men who have been diagnosed with hypertension.

The transition of eldercare responsibility and traditional filial piety concepts and its urban-rural differences in China: an age-period-cohort analysis from 2006 to 2017

BackgroundWith rapid urbanization, massive migration, and non-family–based eldercare involvement, Chinese concepts of eldercare responsibility and filial piety are shifting. We performed age-period-cohort (APC) analyses to assess the transition of old-age pension coverage, eldercare responsibility, and filial piety concepts and its urban-rural differences among Chinese adults using data from the China General Social Survey (2006–2017).MethodsOld-age pension coverage (yes/no) and primary eldercare responsibility (government/offspring/self/sharing) were investigated in 2010, 2012, 2013, 2015, and 2017. Filial piety was evaluated using customized questionnaires in 2006 and 2017. The APC effects were estimated using mixed effects and generalized additive models.ResultsAmong 66,182 eligible participants (mean age: 48.8 years, females: 51.7%) in the six waves, APC analyses indicated that old-age pension coverage increased with aging and over time. Across cohort groups, it grew as the cohort was younger in urban residents but decreased in rural residents. The concept of offspring-based (> 50%) and government/self/offspring-shared eldercare (> 30%) predominated. APC analyses revealed that the offspring-based concept declined with aging (OR = 0.81, 95% CI: 0.79–0.84), whereas the government-based (OR = 1.37, 95% CI: 1.33–1.41) and self-based (OR = 1.55, 95% CI: 1.47–1.63) concepts increased with aging. People born around the 1940s have a comparatively higher possibility to perceive that the primary eldercare responsibility should be undertaken by the government and elder parents. In contrast, people born in the younger cohort were more likely to perceive that adult children are responsible for their parents’ primary eldercare. Filial piety score slightly increased with aging (β = 0.18, SD: 0.05) but decreased as the birth cohort was younger. In addition, rural participants were more likely to perceive offspring-based eldercare and maintain filial piety, and the related urban-rural difference was intensified by aging.ConclusionsThe traditional concept that eldercare solely relies on offspring has changed to relying on multiple entities, including the government and self-reliance. Diluted filial piety in people born in the young cohort requires reinforcement. Moreover, future healthy aging policies need to focus more on urban-rural disparities to promote equity in social well-being.

Free and Compulsory Education as Fundamental Right: A Critical Analysis of Article 25-A of Constitution of Islamic Republic of Pakistan, 1973

Article 25-A of the Pakistani Constitution, introduced in 2010, is a landmark provision that establishes free and compulsory education as a fundamental right for all children between the ages of five and sixteen. This article signifies Pakistan's commitment to providing equitable educational opportunities, regardless of geographical location, gender, or socioeconomic background. While it has led to increased enrolment and awareness, there remain significant challenges related to educational quality, infrastructure, and teacher training. Socioeconomic and cultural factors, such as poverty, rural-urban disparities, cultural norms, security concerns, and language barriers, continue to impact the realization of the right to education. This analysis underscores the need for increased funding, comprehensive policy reforms, and the bridging of socioeconomic and cultural divides to fully implement Article 25-A and provide a brighter future for Pakistan's children and the nation as a whole.

Rural–urban differences in the intergenerational transmission of cognitive capabilities in China: evidence from a Northwestern province of China

PurposeLiterature has shown that the intergenerational transmission of cognitive abilities is stronger for children raised in more advantaged environments. However, there has never been an empirical investigation of this pattern in China. This study examines differences in the intergenerational transmission of cognitive capabilities among mothers and young children in urban and rural subpopulations in China and investigates whether these differences are driven by differences in parental investment in the home environment.Design/methodology/approachData collected from randomly selected 6- to 36-month-old babies and their mothers in a Northwestern province in China was used. Child capabilities were assessed by the Bayley Scales of Infant and Toddler Development (3rd edition). Maternal intelligence quotient (IQ) scores were assessed with the Raven’s Progressive Matrices test. The non-parametric regression methods were used to construct the factor scores of child capabilities. The ordinary least squares (OLS) models were employed to investigate the relations between child cognition, maternal IQ and parental investment.FindingsIn urban households, where most children are raised in a positive home environment, child cognitive scores are strongly correlated with maternal IQ. In rural households, where parental investments are lower and more variable, child cognitive scores are not significantly correlated with maternal IQ but are predicted by differences in parental investments in a cognitively stimulating home environment.Originality/valueThis study provides a unique contribution by utilizing rural–urban disparities in China as a unique natural experiment to investigate differences in the transmission of cognitive capabilities across socioeconomic status (SES). It also provides the first empirical evidence of SES differences in the intergenerational transmission of cognitive capabilities in a developing country. This study reveals that intergenerational mother–child cognition associations are disrupted by poor parental investment in rural households but not in urban households.

How does digitalization affect the urban-rural disparity at different disparity levels: A Bayesian Quantile Regression approach

The digital revolution is bringing profound changes to the production, lifestyle, and governance in urban and rural areas. However, the varying impacts of different digitalization dimensions on urban-rural disparity have been understudied, particularly in developing countries. Based on 1931 county-level administrative units, this study used cluster analysis and a novel Bayesian Quantile Regression approach to explore the digitalization characteristics, and how digitalization influences urban-rural disparity at different disparity levels and in different regions. We found three types of digitalization development, including Balanced Digital Progression (29.26 %), Digital Consumption Powerhouse (17.50 %), and Digital Development Potential (53.24 %). Digitalization played an essential role in alleviating urban-rural disparity, with a more pronounced effect in areas with higher levels of disparity. The access to information infrastructure related to the first-level digital divide may exacerbate the urban-rural disparity, while the digitalization dimensions related to the second-level digital divide could mitigate the urban-rural disparity. Regarding the regional effects, information infrastructure adoption has different impacts on urban-rural disparity across various regions, while digitalization usage is consistently mitigating urban-rural disparities. By comprehensively examining the role of digitalization, we provided a scientific basis for formulating more precise and effective policies for a more balanced and integrated urban-rural development.

Rural-Urban Food Price Inflation Disparities in the United States

Abstract This paper shows that food price inflation varies across rural, urban, and metro counties in the United States. To quantify this disparity, we calculate food price indices using retail scanner data. Our indices suggest that between 2006 and 2020, rural areas had an overall higher food price inflation compared to urban and metro regions, with food price inflation averaging 0.7 percent lower in urban areas and 1.6 percent lower in metro areas. Additionally, we examine shifts in these disparities during key periods. We find that during the Great Recession, these differences were negligible, but in the post-Great Recession years, urban and metro areas consistently had lower food price inflation. However, the onset of the COVID-19 pandemic in 2020 led to a shift, with both urban and metro areas experiencing higher food price inflation, surpassing rural regions.

The Prevalence of Anemia among Pregnant Women in China: A Systematic Review and Meta-Analysis.

The systematic review and meta-analysis were conducted to ascertain the prevalence of anemia, iron deficiency (ID), and iron deficiency anemia (IDA) among Chinese pregnant women. A total of 722 articles on maternal anemia during pregnancy published between January 2010 and December 2020 were compiled, and a systematic review and meta-analysis were conducted on 57 eligible studies including 1,376,204 pregnant women to ascertain the prevalence of anemia and the prevalence in different subgroups. The results showed that the prevalence of anemia, ID, and IDA among pregnant women in China were 30.7% (95% CI: 26.6%, 34.7%), 45.6% (95% CI: 37.0%, 54.2%), and 17.3% (95% CI: 13.9%, 20.7%), respectively. All prevalence increased with the progression of the pregnancy. There were sizable regional variations in the prevalence of anemia, ID, and IDA. Generally, lower prevalence was observed in the economically more advanced eastern region of the country, while the prevalence of ID was higher in the eastern region than that in the western region. The prevalence of anemia and IDA in rural areas was higher than that in urban areas, but ID prevalence was higher in urban areas. In conclusion, the regional differences and urban-rural disparities in the prevalence of anemia indicate the need for more context-specific interventions to prevent and treat anemia. It was found that dietary factors were one of the major causes of anemia, and iron-containing supplements and nutrition counseling could be effective interventions to reduce the prevalence of anemia, ID, and IDA among Chinese pregnant women.

Trends in maternal and child health in China and its urban and rural areas from 1991 to 2020: a joinpoint regression model

The long-term trends in maternal and child health (MCH) in China and the national-level factors that may be associated with these changes have been poorly explored. This study aimed to assess trends in MCH indicators nationally and separately in urban and rural areas and the impact of public policies over a 30‒year period. An ecological study was conducted using data on neonatal mortality rate (NMR), infant mortality rate (IMR), under-five mortality rate (U5MR), and maternal mortality ratio (MMR) nationally and separately in urban and rural areas in China from 1991 to 2020. Joinpoint regression models were used to estimate the annual percentage changes (APC), average annual percentage changes (AAPC) with 95% confidence intervals (CIs), and mortality differences between urban and rural areas. From 1991 to 2020, maternal and child mortalities in China gradually declined (national AAPC [95% CI]: NMRs − 7.7% [− 8.6%, − 6.8%], IMRs − 7.5% [− 8.4%, − 6.6%], U5MRs − 7.5% [− 8.5%, − 6.5%], MMRs − 5.0% [− 5.7%, − 4.4%]). However, the rate of decline nationally in child mortality slowed after 2005, and in maternal mortality after 2013. For all indicators, the decline in mortality was greater in rural areas than in urban areas. The AAPCs in rate differences between rural and urban areas were − 8.5% for NMRs, − 8.6% for IMRs, − 7.7% for U5MRs, and − 9.6% for MMRs. The AAPCs in rate ratios (rural vs. urban) were − 1.2 for NMRs, − 2.1 for IMRs, − 1.7 for U5MRs, and − 1.9 for MMRs. After 2010, urban‒rural disparity in MMR did not diminish and in NMR, IMR, and U5MR, it gradually narrowed but persisted. MCH indicators have declined at the national level as well as separately in urban and rural areas but may have reached a plateau. Urban‒rural disparities in MCH indicators have narrowed but still exist. Regular analyses of temporal trends in MCH are necessary to assess the effectiveness of measures for timely adjustments.

Exploring the mediating influence of acceptance of change: A study on gerontechnology acceptance, mental well-being, and urban–rural disparities among older adults

BackgroundThe global aging population necessitates leveraging technology for older adults' independence and mental well-being. Gerontechnology, tailored for older users, thrives when accessible and accepted, with the pivotal role of acceptance of change shaping its adoption. AimsThis study investigates the mediating role of acceptance of change in the relationship between gerontechnology acceptance and mental well-being among older adults and explores disparities in urban and rural settings Design & MethodsA cross-sectional, correlational design adhering to STROBE guidelines collected data through an interview survey from 802 older adults. Instruments included the Older Adult Structured Survey, Short Version of Senior Technology Acceptance, Acceptance of Change Scale, and the World Health Organization Well-Being Index. ResultsThe results underscore a significant correlation between technology adoption, adaptability, and mental well-being among 60-year-olds and older. Notably, an individual's openness to change significantly influences the technology-mental well-being relationship, emphasizing its impact on overall health. Urban areas exhibit a stronger positive correlation between technology acceptance and mental well-being, whereas rural regions demonstrate a more pronounced negative correlation. ConclusionThis research contributes valuable knowledge for addressing the unique challenges older adults face in diverse geographic settings, paving the way for targeted and effective initiatives. ImplicationsNurses should prioritize understanding the nexus between gerontechnology acceptance, change adaptability, and mental wellness, integrating technology education and culturally sensitive interventions to enhance care strategies for older adults in diverse geographic settings. This study lays the groundwork for developing person-centered geriatric nursing care plans, underscoring the importance of harnessing technology for improved mental well-being.

Urban-rural disparities in the short-term effects of cold and heat on myocardial infarction mortality in Anhui Province, China.

Non-optimal ambient temperatures are risk factors for myocardial infarction (MI) and urban-rural temperature differences in the context of climate change may have caused and will lead to differential association between temperature and MI. We collected daily mean temperature and daily MI deaths from 1 January 2016 to 31 December 2020 in Anhui Province, China. A distributed lag nonlinear model was performed to estimate the area-specific association of heat and cold (defined as the 2.5th and 97.5th percentile of the daily mean temperature) with MI mortality; the random-effects meta-analysis was then used to pool the effects of cold and heat. We found the risk of MI death due to cold was higher in rural areas [relative risk (RR): 1.13, 95% confidence interval (CI): 1.02-1.26, lag0) than in urban areas (RR: 0.99, 95% CI: 0.80-1.21, lag0), whereas the risk of MI death associated with heat was higher in urban areas (RR: 1.14, 95% CI: 1.03-1.27, lag0) than in rural areas (RR: 1.04, 95% CI: 0.99-1.10, lag0). Our findings may help to develop targeted protective strategies to reduce the adverse effects of cold and heat on cardiovascular disease.

Multidimensional energy poverty and its urban-rural and regional disparities: Evidence from China

This study develops a conceptual framework of multidimensional energy poverty by using a multidimensional poverty index that considers energy accessibility, affordability, and service availability. The index is then utilized to evaluate the extent, depth, and intensity of multidimensional energy poverty (MEP) in China. Specifically, this study aims to identify factors that contribute to the urban-rural and regional MEP disparities in China. The results reveal that (1) MEP is widespread in China; (2) Rural areas experience 2.5 times more MEP compared to urban areas, while inland regions have 1.5 times higher MEP rates than coastal regions; and (3) these disparities are primarily caused by low-income levels, lack of non-agricultural employment opportunities, and educational attainment. Therefore, policies targeting low-income, unemployed, and less-educated individuals are necessary to address this issue. In addition, promoting urbanization and eliminating the household registration system are crucial steps to address MEP disparities in China. Furthermore, improving energy infrastructure and increasing knowledge dissemination can also help reduce reliance on traditional energy sources.

Deciphering the digital divide: the heterogeneous and nonlinear influence of digital economy on urban-rural income inequality in China

ABSTRACT This study investigates the heterogeneous and nonlinear impact of digital economy on the urban-rural income disparities in 30 Chinese provinces from 2013 to 2020. The results from moderated multiple regressions and panel threshold regressions consistently indicate that digital economy generally widens China’s urban-rural inequality, but this widening effect diminishes as the digital economy progresses. Furthermore, the influence of digital economy varies depending on local socio-economic factors, including economic development, industrial structure, education level, government expenditure, and openness. Digital economy exerts a stronger influence on exacerbating the inequality in economically developed regions with higher education levels and greater openness, but it helps prevent the inequality from expanding through its interactions with secondary industry development and fiscal expenditure. These findings provide a reference for formulating target strategies in line with local development conditions to bridge the inequality engendered by the digital divide.