Caldwell Julia T, Ford Chandra L, Wallace Steven P, Wang May C, Takahashi Lois M
At the time of study, Julia T. Caldwell was first with the Department of Community Health Sciences at the University of California, Los Angeles (UCLA), Fielding School of Public Health, and then with the Section of Hospital Medicine at the University of Chicago, Chicago, IL. Chandra L. Ford, Steven P. Wallace, and May C. Wang were with the Department of Community Health Sciences at the UCLA Fielding School of Public Health. Lois M. Takahashi was with the UCLA Luskin School of Public Affairs.
Am J Public Health. 2016 Aug;106(8):1463-9. doi: 10.2105/AJPH.2016.303212. Epub 2016 Jun 16.
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.
研究生活在农村地区与城市地区的人群在获得医疗保健方面的差异是否与社会状况有关。
我们将医疗支出面板调查（2005 - 2010年）数据与美国社区调查（2005 - 2009年）和地区卫生资源文件（2010年）的地理数据相链接。我们使用城乡通勤区号将普查区分为农村和城市。受访者样本量从49839到105306不等。结果指标包括是否有常规医疗保健来源、胆固醇筛查、宫颈筛查、在推荐间隔内进行牙科就诊以及医疗保健需求是否得到满足。
农村地区的非裔美国人进行胆固醇筛查（优势比[OR]=0.37；95%置信区间[CI]=0.25，0.57）和宫颈筛查（OR=0.48；95% CI=0.29，0.80）的几率低于城市地区的非裔美国人。农村地区的白人比城市地区的白人进行的筛查和牙科就诊次数更少。关于哪个种族/族裔群体获得医疗保健的情况结果不一。
农村身份在大多数医疗保健使用指标方面带来了额外的不利因素，这与贫困和医疗保健供应无关。
