Rural-Urban Differences in Usual Source of Care and Ambulatory Service Use

Larson, Sharon; Fleishman, John A.

doi:10.1097/01.mlr.0000076053.28108.f2

Cited by 107 publications

(112 citation statements)

References 19 publications

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“…The authors concluded that a non-dichotomous definition may reveal hidden variation. 46 Hawley used both RUCCs and UICs to describe the variation in colon cancer incidence and mortality rates in Texas and concluded that finer delineations on the rural end of the scales revealed heterogeneity in rates with respect to African-Americans. 47 Similarly, we found much lower rates of mammography-detected breast cancer in North Carolina (NC) in the most rural areas using the UIC taxonomy; these differences would have been attenuated had we used a dichotomous measure.…”

Section: Us Census Urban and Ruralmentioning

confidence: 99%

Defining Urban and Rural Areas in U.S. Epidemiologic Studies

Hall

Kaufman²,

Ricketts³

2006

J Urban Health

315

280

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Among epidemiologists, there has been increasing interest in the characteristics of communities that influence health. In the United States, the rural health disparity has been a recent focus of attention and made a priority for improvement. While many standardized definitions of urban and rural exist and are used by social scientists and demographers, they are found in sources unfamiliar to health researchers and have largely not been used in public health studies. This paper briefly reviews some available definitions of urban and rural for American geographic subunits and their respective strengths and weaknesses. For example, some definitions are better suited than others for capturing access to health care services. The authors applied different definitions to breast cancer incidence rates to show how urban/rural rate ratio comparisons would vary by choice of definition and found that dichotomous definitions may fail to capture variability in very rural areas. Further study of the utility of these measures in health studies is warranted.

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Section: Us Census Urban and Ruralmentioning

confidence: 99%

Defining Urban and Rural Areas in U.S. Epidemiologic Studies

Hall

Kaufman²,

Ricketts³

2006

J Urban Health

315

280

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“…80 While many rural residents report having a health care provider, they tend to report fewer annual visits to health care providers than do residents of large metropolitan areas. 81 Within an urban environment, geography can influence the likelihood of health care use. In New York City, the overall revascularization rates among patients hospitalized with MI were higher in an affluent community than in two socioeconomically disadvantaged communities.…”

Section: Barriers To Accessmentioning

confidence: 99%

Health disparities: A barrier to high-quality care

Mullins

Blatt²,

Gbarayor³

et al. 2005

American Journal of Health-System Pharmacy

101

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Purpose-Disparities in the treatment of cardiovascular disease, diabetes mellitus, and cancer among the sexes and racial groups and possible interventions are discussed.Summary-The ongoing process to identify and reduce health disparities has engaged numerous federal agencies as they monitor the nation's progress toward policy-driven and health-related objectives. Cardiovascular disease disproportionately affects minority groups and is the leading cause of death among women in the United States, and both groups receive suboptimal care for the disease. Disparities in the treatment of diabetes mellitus in African Americans, women, patients with less than a high school education, and the elderly have been found. Many minority groups continue to suffer disproportionately from cancer. Racial disparities also exist in cancer screening and treatment. Minorities are underrepresented in clinical trials for multiple reasons, many of which may be related to cultural beliefs. At all levels of coinsurance, the poor are less likely to seek preventive care. Adherence to national screening and treatment guidelines, clinical trial recruitment and participation, addressing language and geographic barriers, and increasing access to insurance are part of the coordinated efforts required to reduce health disparities. Because pharmacists influence patients' health status directly through pharmaceutical care and indirectly by engaging patients in their treatment, it is essential for pharmacists to be able to provide culturally competent care.Conclusion-Despite significant efforts over the past several years, health disparities continue to exist, particularly among minority groups. Interventions aimed at eliminating these disparities should include ensuring cultural competence among health care providers and improving health literacy among patients.

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“…Demographic characteristics included race/ethnicity (white, African American, or Latina), age (<45, 45-49, 50-54, 55-59, or 60-64 years), marital status (married, widowed, divorced/separated, or never married) and area of residence. The urban/rural continuum of a woman's residence was determined by ZIP code/county of subject residence using the Urban Influence Coding scheme (Larson & Fleishman 2003). This measure is a 10-level summary variable with the value 0 representing the most urban areas and the value 9 representing the most rural areas.…”

Section: Dependent Variables: Intermediate Outcomes Of Diabetes Carementioning

confidence: 99%

Diabetes care among veteran women with disability

Tseng

Sambamoorthi

Tiwari

et al. 2006

Women's Health Issues

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Objective-The primary objective of this study was to analyze predictors of diabetes care consistent with performance standards among women Veterans Health Administration (VHA) clinic users with disability enrollment status.Methods-This is a retrospective cohort study using VHA and Medicare files of VHA clinic users with diabetes. Diabetes care measures consisted of annual testing for hemoglobin A 1c (>9%) and LDL-C (HbA 1c ), low-density lipoprotein cholesterol (LDL-C), and poor HbA 1c (≥130 mg/dL) control in fiscal year 2000. Chi-square tests and logistic regressions were used to assess subgroup differences in diabetes care. Independent variables included demographic characteristics and physical and psychiatric comorbidities.Population-Study population was based on veteran women <65 years of age who used VHA clinics; we identified 2,344 women as having coexisting disability and diabetes and 2,766 women with diabetes and without disability.Findings-Among veteran women with diabetes and disability, 65% received ≥1 HbA 1c test, and 54% received a LDL-C test; 25% and 30% had poor HbA 1c and LDL-C control, respectively. In logistic regressions, none of the independent variables had significant effects on poor HbA 1c or LDL-C control, except that African Americans were more likely to have poor HbA 1c control than whites. Significant age effects were noted in rates of HbA 1c and LDL testing. Comparison of diabetes care measures between women with and without disability indicated that those with disability were more likely to receive HbA 1c and LDL-C tests; no significant differences in HbA 1c and LDL-C control were noted.Conclusions-Disability status of women veterans was not a barrier to diabetes care consistent with performance standards. Our findings suggest that to improve diabetes care, subgroup-specific interventions, rather than a global approach, are warranted.

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Rural-Urban Differences in Usual Source of Care and Ambulatory Service Use

Cited by 107 publications

References 19 publications

Defining Urban and Rural Areas in U.S. Epidemiologic Studies

Defining Urban and Rural Areas in U.S. Epidemiologic Studies

Health disparities: A barrier to high-quality care

Diabetes care among veteran women with disability

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