Rural Versus Urban Research Articles

Intersection of Living in a Rural Versus Urban Area and Race/Ethnicity in Explaining Access to Health Care in the United States.

To examine whether living in a rural versus urban area differentially exposes populations to social conditions associated with disparities in access to health care. 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. African Americans in rural areas had lower odds of cholesterol screening (odds ratio[OR] = 0.37; 95% confidence interval[CI] = 0.25, 0.57) and cervical 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. Rural status confers additional disadvantage for most of the health care use measures, independently of poverty and health care supply.

Rural Versus Urban Hospitals in Poland. Hospital's Financial Health Assessment

Literature studies suggest, that hospitals in rural areas are usually smaller and more sensitive to changes in health policies. The aim of this research is to assess and compare the financial condition of rural and urban hospitals. Basing on literature studies, we have assumed, that rural hospitals are characterized by lower profitability, higher debt and lower overall financial condition. We have proved, that rural hospital, although smaller, have lower debt ratios and better financial condition (especially in terms of profitability and liquidity). We have applied statistical tool and authorial methodology (“The M Method”), which basis on synthetic indicators of financial condition.

Assessing Differences in the Availability of Opioid Addiction Therapy Options: Rural Versus Urban and American Indian Reservation Versus Nonreservation.

Opioid misuse is a large public health problem in the United States. Residents of rural areas and American Indian (AI) reservation/trust lands represent traditionally underserved populations with regard to substance-use disorder therapy. Assess differences in the number of opioid agonist therapy (OAT) facilities and physicians with Drug Addiction Treatment Act (DATA) waivers for rural versus urban, and AI reservation/trust land versus non-AI reservation/trust land areas in Washington State. The unit of analysis was the ZIP code. The dependent variables were the number of OAT facilities and DATA-waivered physicians in a region per 10,000 residents aged 18-64 in a ZIP code. A region was defined as a ZIP code and its contiguous ZIP codes. The independent variables were binary measures of whether a ZIP code was classified as rural versus urban, or AI reservation/trust land versus non-AI reservation/trust land. Zero-inflated negative binomial regressions with robust standard errors were estimated. The number of OAT clinics in a region per 10,000 ZIP-code residents was significantly lower in rural versus urban areas (P = .002). This did not differ significantly between AI reservation/trust land and non-AI reservation/trust land areas (P = .79). DATA-waivered physicians in a region per 10,000 ZIP-code residents was not significantly different between rural and urban (P = .08), or AI reservation/trust land versus non-AI reservation/trust land areas (P = .21). It appears that the potential for Washington State residents of rural and AI reservation areas to receive OAT is similar to that of residents outside of those areas; however, difficulties in accessing therapy may remain, highlighting the importance of expanding health care insurance and providing support for DATA-waivered physicians.

Analyzing Rural Versus Urban Differences in Career Dissatisfaction and Plans to Leave Among Pennsylvanian Physicians

This study estimates whether physicians in rural Pennsylvania have higher odds of career dissatisfaction and plans to leave patient care in the next 6 years, compared to their urban counterparts. Rural-urban differences were estimated across specific subgroups of physicians (gender, race, and specialty) and with regard to specific sources of career dissatisfaction. The 2012 Pennsylvania Health Workforce Survey of Physicians allowed for analysis of 17,444 physicians younger than 55 years old actively practicing patient care. Multivariate, logistic regression was performed to estimate the associations with 2 outcome areas: career dissatisfaction and plans to leave patient care in the next 6 years. Controls included rural setting, age, sex, race, work hours, specialty, and practice characteristics. Over 12% of under-55 physicians are dissatisfied with their careers and over 18% report plans to leave patient care in the next 6 years. Rural physicians in Pennsylvania have 18.6% higher odds of reporting career dissatisfaction and 29.5% higher odds of leaving patient care in the next 6 years (P < .01 for each) versus their urban counterparts. Rates of dissatisfaction and potential attrition among younger physicians are not insignificant, with a stronger association with rural practice. Given the large number of rural health shortage areas, better understanding this association is important to health care providers and policy makers. Regression results suggest that higher rural odds are related more to physician work (i.e., stress, practice demands, and lack of autonomy) and family situations and less related to income concerns.

Disparity in Breast Cancer Late Stage at Diagnosis in Missouri: Does Rural Versus Urban Residence Matter?

Despite the fact that black women have a lower incidence of breast cancer compared to white women, black women experience higher death rates than any other group. We examined the stage of breast cancer presentation by race and geographic region using population-based breast cancer incidence in all 115 counties in the state of Missouri. We used 2003-2008 breast cancer incidence data from Missouri Cancer Registry and Research Center. County of residence was categorized as urban or rural using the rural-urban continuum code. We computed the conditional proportion of stage at diagnosis by race and metropolitan status and also used Pearson's chi-squared test with Yates' continuity correction to determine statistical significance of association. Results of the study indicate that a greater proportion of black women (38.8%) compared to white women (30.2%) were diagnosed with more advanced breast metastasis. Our results further suggest that stage at diagnosis depended on county of residence or metropolitan status (p = .04). Women living in non-metropolitan counties were slightly more likely to have late-stage breast cancer than their metropolitan counterparts (32.0 vs 30.7%). Overall, black women had 1.5-fold increased odds of late-stage breast cancer diagnosis compared to their white counterparts (OR = 1.50; 95% CI, 1.39, 1.63; p < 0.0001). While the odds of late diagnosis among women living in non-metropolitan or rural counties was over 11% higher compared with their metropolitan or urban counterpart. The current study corroborates previous findings that the risk of late-stage breast cancer diagnosis was higher among women residing in non-metropolitan rural counties.

Rural Versus Urban Health Service Utilization and Outcomes for Renal Patients in New South Wales: Protocol for a Data Linkage Study.

BackgroundKidney disease is a significant burden on health systems globally, with the rising prevalence of end stage kidney disease in Australia mirrored in many other countries. Approximately 25% of the Australian population lives in regional and rural areas and accessing complex tertiary services is challenging.ObjectiveWe aim to compare the burden and outcomes of chronic kidney disease and end stage kidney disease in rural and urban regions of New South Wales (Australia’s most populous state) using linked health data.MethodsThis is a retrospective cohort study and we have defined two cohorts: one with end stage kidney disease and one with chronic kidney disease. The end stage kidney disease cohort was defined using the Australia and New Zealand Dialysis and Transplant Registry, identifying all patients living in NSW receiving renal replacement therapy at any time between 01/07/2000 and 31/07/2010. The chronic kidney disease cohort used the NSW Admitted Patient Data Collection (APDC) to identify patients with a diagnostic code relating to chronic renal failure during any admission between 01/07/2000 and 31/07/2010. Both cohorts were linked to the NSW APDC, the Registry of Births, Deaths and Marriages, and the Central Cancer Registry allowing derivation of outcomes by categories of geographical remoteness.ResultsTo date, we have identified 10,505 patients with 2,384,218 records in the end stage kidney disease cohort and 159,033 patients with 1,599,770 records in the chronic kidney disease cohort.ConclusionsThis study will define the geographical distribution of end stage and chronic kidney disease and compare the health service utilization between rural and urban renal populations.

Cardiovascular Disease Risk Factors Assessment in Urban Versus Rural Women of Same Ethnicity

Objectives: The difference between modern lifestyle in urban areas and the traditional way of life in rural areas may be a reason for increased prevalence of cardiovascular disorders in urban population. The aim of the study was to assess the risk factors for cardiovascular disease such as obesity, blood pressure and lipid profile in rural women as compared to urban women of same ethnic groups.Methods: 180 female subjects (age group 30-40 years) were studied, out of which 90 were from rural areas and 90 from urban areas. The estimation of obesity was done by measuring waist hip ratio (WHR) and body mass index (BMI). Systolic and diastolic blood pressure (BP) was recorded. Lipid profile (Total cholesterol, triglycerides, low density lipoprotein cholesterol, very low density lipoprotein cholesterol and high density lipoprotein cholesterol) was done in both the groups.Results: Significant increase in BMI (p<0.001), WHR (p<0.001), systolic blood pressure (p<0.01), total cholesterol (p<0.01), triglycerides (p<0.01), low density lipoprotein cholesterol (p<0.01) and very low density lipoprotein cholesterol (p<0.01) was found in urban women as compared to rural women. No significant difference was observed in diastolic blood pressure and high density lipoprotein cholesterol.Conclusion: This study shows that the urban women are more obese, have higher blood pressure and adverse plasma lipid profile thereby making them more vulnerable to cardiovascular diseases as compared to rural women.

Climate Change in Urban Versus Rural Areas

The most important anthropogenic influences on climate are the emissions, changes in land use, such as urbanization aural areasnd agriculture. The urban environment has distinctive bioclimatical factors in relation to rural areas. The process of urbanization alters natural surface and atmospheric conditions. Urban areas are characteristic by increased rainwater surface runoff, increased temperatures and decreased evaporation. Exactly evaporation warms the rural surface more than the urban. The paper concerns on the impacts of urbanization that are evaluated by observations in cities with those in rural areas – not so populated and with smaller built areas. We use and asses the difference between trends in monthly average temperatures and trends in monthly precipitations in the cities and the corresponding trends in rural areas. For the trend analysis, the Mann-Kendall nonparametric test is used. Our results show differences in trends in villages and cities. Observed are increased trends in temperature and decreased trends in precipitation due to urban and land-use changes.

Future Sex Educator Perceptions of Rural Versus Urban Instruction: A Case for Community-Centered Sexual Health Education

Instructors of sexual health courses in rural areas face unique challenges as they are often forced to use school-based prevention curricula field-tested in urban areas. Research has yet to consider what future sex educators’ regional expectations are for their profession and how those expectations might have an impact on the classroom. Drawing from interviews with 26 sex-educators-in-training, we find that future educators tended to expect that rural communities would be less diverse, more conservative, and less informed about sexual health matters, even though research demonstrates that today's rural communities inconsistently align with those perceptions.

A survey comparison of rural versus urban residents and household preparedness.

The purpose of this study was to (a) determine how effective the state's campaign has been in informing rural and urban residents who are reliant on electronic medical equipment about the campaign and (b) determine how effective the state campaign has been in informing medical suppliers about the campaign. Approximately 2,000 residents were interviewed about their understanding of the emergency preparedness campaign. Results indicate that approximately 74% of the rural residents and 82% or the urban residents using electronic medical equipment were unaware of the state's disaster preparedness program. Implications for home health clinicians are discussed.

Do Perceptions of Direct-to-Consumer Pharmaceutical Advertising Vary Based on Urban Versus Rural Living?

This study explores the connection between perceptions of direct-to-consumer (DTC) advertising based on where people live and shop. Urban consumers were found to be more skeptical of DTC advertising, but more likely to believe that physicians select pharmaceuticals based on the efficacy of the product. Those living in rural areas were more motivated to visit a doctor and more likely to feel an equal doctor−patient relationship after exposure to DTC advertising. Interaction effects among gender, income, and education were detected, as well as an interaction effects between location and income on views of DTC advertising.

HIV and HCV Serostatus and Knowledge Among Patients in Urban Versus Rural Methadone Maintenance Clinics in Kunming

The purpose of this study was to document the prevalence of Human Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV) among urban and rural methadone maintenance treatment (MMT) patients and to examine differences in knowledge of HIV and HCV among this population. We compared 147 MMT patients attending urban versus rural clinics in Kunming, Yunnan, China, concerning their serostatus and knowledge of HIV and HCV. The rates of HIV and HCV seropositive status were higher among rural patients. Both urban and rural patients showed limited HIV and HCV knowledge. Recent opioid injection and geographic area were strong predictors of HIV and HCV serostatus. The lack of knowledge of HIV and HCV among both urban and rural MMT patients suggests the need to strengthen current HIV and HCV education programs in MMT clinics. In addition, prevention programs should take into consideration geographic characteristics of the target population.

Comparing Supports for LGBT Aging in Rural Versus Urban Areas

Studies of rural populations typically underrepresent lesbian, gay, bisexual, and transgender (LGBT) older adults. This secondary analysis examined data from a nationwide sample of LGBT baby boomers (n = 1201). Geographic differences with respect to self-reported outness, acceptance of sexual identity, social and familial support, and household income were assessed with one-way analyses of variance. Guardedness about one's sexual identity and household asset levels were assessed with chi-square analyses. Rural individuals reported lower levels of outness, guardedness with people including siblings and close friends, and lower levels of household income. Providers should consider strategies for connecting older rural LGBT adults for potential care and support.

Characteristics of the Residential Neighborhood Environment Differentiate Intimate Partner Femicide in Urban Versus Rural Settings

A growing body of work examines the association between neighborhood environment and intimate partner violence (IPV). As in the larger literature examining the influence of place context on health, rural settings are understudied and urban and rural residential environments are rarely compared. In addition, despite increased attention to the linkages between neighborhood environment and IPV, few studies have examined the influence of neighborhood context on intimate partner femicide (IPF). In this paper, we examine the role for neighborhood-level factors in differentiating urban and rural IPFs in Wisconsin, USA. We use a combination of Wisconsin Violent Death Reporting System (WVDRS) data and Wisconsin Coalition Against Domestic Violence (WCADV) reports from 2004 to 2008, in concert with neighborhood-level information from the US Census Bureau and US Department of Agriculture, to compare urban and rural IPFs. Rates of IPF vary based on degree of rurality, and bivariate analyses show differences between urban and rural victims in race/ethnicity, marital status, country of birth, and neighborhood characteristics. After controlling for individual characteristics, the nature of the residential neighborhood environment significantly differentiates urban and rural IPFs. Our findings suggest a different role for neighborhood context in affecting intimate violence risk in rural settings, and that different measures may be needed to capture the qualities of rural environments that affect intimate violence risk. Our findings reinforce the argument that multilevel strategies are required to understand and reduce the burden of intimate violence, and that interventions may need to be crafted for specific geographical contexts.

Causes, Consequences, and Prevention of Burnout Among Substance Abuse Treatment Counselors: A Rural Versus Urban Comparison

Substance abuse counselors are vulnerable to burnout, which has negative repercussions for the counselor, employing organization, and clients. However, little is known about differences in counselor burnout from the counselors' perspective in rural versus urban treatment centers. In 2008, focus group data from 28 rural and urban counselors in a southern state were analyzed, revealing three burnout themes across all counselors: causes, consequences, and prevention. However, there were various differences between rural and urban counselors in subthemes, with only rural counselors citing office politics and low occupational prestige as causes of burnout. Only urban counselors reported responses endorsing the subthemes of role reversal, clients trying to choose their counselors, and changing jobs as consequences of burnout. All counselors cited coworker support, clinical supervision, and self-care as important strategies for managing burnout. In sum, context clearly matters as rural counselors cited more causes of burnout; yet, the implications of burnout are universal in that they often lead to poor quality clinical care. There is a continued need for greater understanding of addiction as a disease, which would reduce stigma, especially in rural areas, as well as increase the prestige and earning potential of the substance abuse counseling occupation.

The Influence of Rural Versus Urban Residence on Utilization and Receipt of Care for Chronic Low Back Pain

(1) To describe demographic and health-related characteristics among rural/urban residents with chronic low back pain (LBP); (2) To determine if the utilization of diagnostics and treatments differs between rural and urban residents with chronic LBP; and (3) To determine the association between rural/urban residence and health care provider usage and if associations differ by race or gender. A 2006 cross-sectional telephone survey of a representative sample of North Carolina residents. Subjects with chronic LBP were questioned regarding their health and health care use. Wald and chi-square tests were used to determine differences between demographic and health-related characteristics of rural/urban residents. Logistic regression was used to determine the association between rural/urban residence and health care provider use. Differences in race or gender were explored with stratified analysis with a P < .10. 588 residents of North Carolina with self-reported chronic LBP sought care from a provider in the previous year. In bivariate analyses, when compared to urban residents, rural residents were younger, more likely to be uninsured, reported significantly higher levels of disability, and reported more depression/sadness. Rural residents were less likely to receive care from a rheumatologist (adjusted odds ratio [aOR] 0.47 [95% CI, 0.22-0.99]). Rural blacks were less likely to receive care from a physical therapist when compared to urban blacks (aOR 0.26 [95% CI, 0.07-0.87]). Despite similarities of high provider use, imaging and therapeutics, when compared to urban residents, rural residents reported higher levels of functional limitation and depression.

Maternal Obesity and Gestational Weight Gain in Rural Versus Urban Dwelling Women in South Carolina

An unhealthy prepregnancy weight and/or gaining an inappropriate amount of weight during pregnancy increase the risk for poor pregnancy and birth outcomes. To our knowledge, no studies to date have examined differences in prepregnancy body mass index (BMI) and gestational weight gain (GWG) patterns by rurality. The 2004-2006 South Carolina birth certificate data (n = 132,795) were used. Rurality of residence was determined using Rural-Urban Commuting Area (RUCA) codes. Mothers were categorized as underweight (<18.5 kg/m(2)), normal weight (18.5-24.9), overweight (25.0-29.9), and obese (≥30.0) using their prepregnancy BMI and as having inadequate, adequate, or excessive GWG according to the Institute of Medicine's 2009 GWG guidelines. Chi-square tests and adjusted multinomial logistic regression were used in analysis. Rural women had higher odds of being overweight and obese compared to urban women. This relationship was found to be partially explained by the higher proportion of minorities living in rural areas. The relationship between GWG and residence type varied by BMI category. Specifically, among normal weight women, rural women had increased odds of inadequate GWG. Among overweight women, rural women had decreased odds of excessive GWG. In obese women, rural women had decreased odds of both inadequate and excessive GWG. Rural women were more likely to have an unhealthy prepregnancy weight than urban women. However, rural residence was found to be protective against unhealthy GWG in overweight and obese women. Future research exploring reasons for these findings and confirmation of these results in other populations is necessary.

Relation Between Dysmenorrhea and Body Mass Index in Adolescents with Rural Versus Urban Variation

To find out the relation between the frequency of dysmenorrhea and body mass index in adolescents and to assess the impact of socio-demographic factors, especially rural/urban variation in the frequency of dysmenorrhea. Cross-sectional study of 200 urban and 200 rural school going adolescent girls at Udaipur and Bedla Districts, Rajasthan. Of the 400 girls, the prevalence of dysmenorrhea was found to be very high (81.5% rural and 76% urban). In the rural setup, of the total girls with mild dysmenorrhea, 71.84% had BMI<16.5, with 27.18% underweight. All girls with moderate and severe dysmenorrhea had BMI<16.5. In the urban setup, of all girls with mild dysmenorrhea, 38.05% had BMI<16.5 and 54.86% were underweight. All girls with severe and 80% with moderate dysmenorrhea had BMI<16.5. All girls with no dysmenorrhea had normal BMI. There was significant rural versus urban variation. Relation between dysmenorrhea and BMI was found to be significant (p<0.01) with increased prevalence in the low BMI group. Hence, improving the nutritional status of adolescent girls may reduce dysmenorrhea.

Rural Versus Urban Comparison: Physical Activity and Functioning Following Coronary Artery Bypass Surgery

The purpose of this sub-analysis was to compare the early recovery of elderly patients following coronary artery bypass surgery (CABS) by geographic location (urban/rural) on physical functioning and physical activity. The sample was 124 subjects who had been in the usual care group (or control group) of a randomized controlled trial. Subjects were categorized into geographic locales using Rural Urban Commuting Area (RUCA) codes: urban n=35, large rural n=17, small rural n=23 and isolated rural n=33. Measures included the Medical Outcomes Study Short-Form 36 and the RT3® accelerometer. Mixed linear models were used to analyze the data. No significant differences were found for physical functioning by RUCA group. However, there was a statistically significant difference for physical activity, for average kcals/kg/ per day (F = 3.01, p < .05) and average daily activity counts (F = 3.95, p <.01), with the subjects in large rural communities having significantly (p < 0.05) more average kcals/kg per day than urban subjects (M = 29.04 and M = 27.25 respectively). Subjects in the large rural also had significantly (p < .005) more average daily activity counts than urban (M = 216635 and M = 161221 respectively). This is the first study to compare early recovery functioning and activity outcomes of CABS subjects by rural/urban locations. Additional study is warranted to evaluate why these differences exist and the potential need to tailor interventions for CABS based on geographic location.

Su1134 Prevalence and Characteristics of Eosinophilic Esophagitis in Rural Versus Urban Populations

Su1134 Prevalence and Characteristics of Eosinophilic Esophagitis in Rural Versus Urban Populations