State health disparities research in Rural America: Gaps and future directions in an era of COVID‐19

Stone, Lisa Cacari; Roary, Mary; Diana, Augusto; Grady, Patricia A.

doi:10.1111/jrh.12562

Cited by 25 publications

(24 citation statements)

References 25 publications

(26 reference statements)

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“…As this study suggests, depression was already a problem before the pandemic began in rural communities in the United States. Considering these findings, taken together with other research that has found severe economic impacts on rural areas due to the pandemic (Cacari Stone et al, 2021; Mueller et al, 2021) response and recovery policies must seek to reduce mental health inequities in rural communities, rather than seek to return these communities to their prepandemic depression status.…”

Section: Discussionmentioning

confidence: 85%

Changes in depression levels for U.S. rural communities before and after the start of the COVID-19 pandemic.

Cannon¹,

Ferreira²,

Buttell³

et al. 2022

Traumatology

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The objective of this research is to identify whether there were statistically significant changes in depression severity for rural residents in the United States before the COVID-19 pandemic and after its start in 2020. This study uses paired-sample t tests to differentiate between depression levels, measured by the Patient Health Questionnaire-9, before the pandemic and after its start for a sample of rural residents (n = 324), as well as a subsample of women (n = 224) and Black clients (n = 55). Results indicate that the average Patient Health Questionnaire-9 decreased from 11.86 to 11.77 for the total sample and from 12 to 11.99 for the subsample of women, whereas the subsample of Black residents increased from 10.58 to 11.27 for prepandemic versus postpandemic levels, though the differences are not statistically significant. Given the urban/rural differences in coping with challenges stemming from the COVID-19 pandemic, the United States cannot have a one-size-fits-all pandemic response policy.

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Section: Discussionmentioning

confidence: 85%

Changes in depression levels for U.S. rural communities before and after the start of the COVID-19 pandemic.

Cannon¹,

Ferreira²,

Buttell³

et al. 2022

Traumatology

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“…Rural Health introduces a keen set of challenges, most notably, often affecting the population's overall health and health outcomes. Due to a multitude of risk factors such as geographic isolation, lack of access to healthcare, lower socioeconomic status, and limited job opportunities, rural populations are subjected to lower health outcomes in comparison to their urban counterparts [34]. Rural communities tend to be older with more than 8 million people who are 65 years of age or older [35].…”

Section: Rural Healthmentioning

confidence: 99%

“…Rural communities tend to be older with more than 8 million people who are 65 years of age or older [35]. These populations are at a greater risk of dying from cancer, heart disease, accidental injury, chronic lower respiratory disease, and stroke [34,36]. Rurality accompanied by pre-existing comorbidities appears to significantly lower the health outcomes of rural Americans.…”

Section: Rural Healthmentioning

confidence: 99%

A Systematic Review: Rural Health Disparities During the COVID-19 Pandemic in the United States

Harrell¹,

Jiménez²

2023

Preprint

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COVID-19 has proven to be detrimental across the globe, most notably affecting the United States at an alarming rate compared to comparable countries. The pandemic has had multifactorial implications on the way communities in the United States prevent, prepare for, and address the virus; however, the impact of the pandemic on rural health is less well understood. Historically, rural communities have faced a unique set of challenges regarding accessing and receiving adequate healthcare, addressing chronic illness, and eliminating health disparities closely associated with the population’s socioeconomic status; the pandemic has exacerbated these challenges. The purpose of the current study was to conduct a systematic review of the literature to evaluate the effect of the COVID-19 pandemic on rural populations both at the individual and community level. Results indicated that rural health disparities increased both at the individual and system-wide levels as a direct result of the pandemic. Budget cuts significantly affected the infrastructure of rural hospitals resulting in them being unequipped to handle such high volumes of COVID-19 cases. The lack of infectious disease specialists, access to larger medical centers with substantial numbers of ICU beds and ventilators, and an overall lack of preparedness overwhelmed rural communities. Although comorbidities such as diabetes and heart disease were associated with poorer health outcomes for a multitude of reasons, the lack of clinic and physician availability for routine care during the pandemic further exacerbated the clinical link from COVID-19 positivity to comorbidities. Furthermore, mental health deteriorated as substance use increased to a greater extent in rural communities compared to urban, during the pandemic. This study shows that health comorbidities, mental health, substance use, health literacy, access to healthcare, among others can serve as key indicators for improving healthcare in rural communities. Future studies should seek to identify key issues that disproportionately affected rural communities in comparison to their urban counterparts considering the pandemic, as well as identify gaps in the availability of rural health resources that can improve the lives of millions of Americans now and during the next pandemic.

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“…Rural areas account for nearly 20% of the US population and are increasingly diverse. 11 , 12 Residents in rural areas may experience a negative impact to their health and well‐being because of shortages of health care facilities and providers and higher rates of poverty. 11 , 13 , 14 Due to lack of high‐speed internet, limited access to providers, and lower health insurance rates, underserved patient populations who reside in rural areas face challenges receiving primary and contraceptive care.…”

Section: Introductionmentioning

confidence: 99%

“…FQHCs’ role in access to care is particularly important in rural America. Rural areas account for nearly 20% of the US population and are increasingly diverse 11,12 . Residents in rural areas may experience a negative impact to their health and well‐being because of shortages of health care facilities and providers and higher rates of poverty 11,13,14 .…”

Section: Introductionmentioning

confidence: 99%

Contraceptive care service provision via telehealth early in the COVID‐19 pandemic at rural and urban federally qualified health centers in 2 southeastern states

Beatty

Smith

Khoury

et al. 2022

The Journal of Rural Health

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Purpose To investigate telehealth use for contraceptive service provision among rural and urban federally qualified health centers (FQHCs) in Alabama (AL) and South Carolina (SC) during the initial months of the COVID‐19 pandemic. Methods This is a mixed‐methods study using data from the FQHC Contraceptive Care Survey and key informant interviews with FQHC staff in AL and SC conducted in 2020. Differences between rural and urban clinics in telehealth use for contraceptive service provision were assessed with a chi‐square test of independence. Interviews were audio recorded, transcribed, and coded to identify facilitators and barriers to telehealth. Findings Telehealth for contraceptive care increased during the early months of the pandemic relative to prepandemic. Fewer rural clinics than urban clinics provided telehealth for contraceptive counseling (16.3% vs 50.6%) ( P = .0002), emergency contraception (0.0% vs 16.1%) ( P = .004), and sexually transmitted infection care (16.3% vs 34.6%) ( P = .031). Key facilitators of telehealth were reimbursement policy, electronic infrastructure and technology, and funding for technology. Barriers included challenges with funding for telehealth, limited electronic infrastructure, and reduced staffing capacity. Conclusions Differences in telehealth service provision for contraceptive care between rural and urban FQHCs highlight the need for supportive strategies to increase access to care for low‐income rural populations, particularly in AL and SC. It is essential for public and private entities to support the implementation and continuation of telehealth among rural clinics, particularly, investing in widespread and clinic‐level electronic infrastructure and technology for telehealth, such as broadband and electronic health record systems compatible with telehealth technology.

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State health disparities research in Rural America: Gaps and future directions in an era of COVID‐19

Cited by 25 publications

References 25 publications

Changes in depression levels for U.S. rural communities before and after the start of the COVID-19 pandemic.

Changes in depression levels for U.S. rural communities before and after the start of the COVID-19 pandemic.

A Systematic Review: Rural Health Disparities During the COVID-19 Pandemic in the United States

Contraceptive care service provision via telehealth early in the COVID‐19 pandemic at rural and urban federally qualified health centers in 2 southeastern states

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