Yisma Engida, Jones Martin, Pauh Lee San, Walsh Sandra, Jones Sara, May Esther, Gillam Marianne
Department of Rural Health, University of South Australia, Whyalla Norrie and Mount Barker, South Australia, Australia.
IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia.
J Rural Health. 2025 Mar;41(2):e12884. doi: 10.1111/jrh.12884. Epub 2024 Oct 3.
In Australia, there is limited research regarding the effect of rurality on health care utilization using longitudinal data.
We analyzed data from four annual waves (2009, 2013, 2017, and 2021) of the longitudinal Household, Income and Labour Dynamics in Australia (HILDA) Survey to examine changes in the health care utilization over time among urban and rural residents. Poisson regression models estimated adjusted incidence rate ratios (aIRR) and 95% confidence intervals (CIs) for rural versus urban residents, accounting for a range of health-related and sociodemographic characteristics. Health care utilization was measured using four key indicators: visits to family doctor or another general practitioner (GP visits from hereon), hospital admissions, total nights' stay in the hospital, and prescribed medications taken on a regular basis.
The aIRR for GP visits among rural versus urban Australian residents increased over time, from 0.89 (95% CI: 0.82 to 0.97) in 2009 to 0.96 (95% CI: 0.89 to 1.04) in 2021 although not consistently increased in a statistically significant manner. While there were no consistent temporal patterns, our analysis found that rural residents experienced higher number of hospital admissions (aIRR, 1.12 to 1.15) and number of nights in the hospital in the last 12 months (aIRR, 1.18 to 1.25) compared to urban residents. Moreover, rurality had little to no effect on the number of prescribed medications taken on a regualar basis in the 12 months preceding the HILDA Surveys in 2013, 2017, and 2021.
This study found that GP visits were less frequent among rural residents compared to metropolitan residents in 2009, indicating health care access disparities between rural and urban areas in Australia. However, the differences in GP visits between rural and urban areas were less pronounced from 2013 to 2021.
在澳大利亚，关于农村地区对利用纵向数据进行医疗保健利用的影响的研究有限。
我们分析了澳大利亚家庭、收入和劳动力动态纵向调查（HILDA）四个年度波次（2009年、2013年、2017年和2021年）的数据，以研究城乡居民随时间推移在医疗保健利用方面的变化。泊松回归模型估计了农村居民与城市居民的调整发病率比（aIRR）和95%置信区间（CI），同时考虑了一系列与健康相关和社会人口学特征。医疗保健利用情况通过四个关键指标来衡量：看家庭医生或其他全科医生（以下简称全科医生就诊）、住院、住院总天数以及定期服用的处方药。
澳大利亚农村居民与城市居民相比，全科医生就诊的aIRR随时间增加，从2009年的0.89（95%CI：0.82至0.97）增至2021年的0.96（95%CI：0.89至1.04），尽管并非一直以统计学显著方式增加。虽然没有一致的时间模式，但我们的分析发现，与城市居民相比，农村居民在过去12个月的住院次数（aIRR，1.12至1.15）和住院天数（aIRR，1.18至1.25）更多。此外，在2013年、2017年和2021年HILDA调查前的12个月里，农村地区对定期服用的处方药数量几乎没有影响。
本研究发现，2009年农村居民的全科医生就诊频率低于大城市居民，这表明澳大利亚城乡地区在医疗保健可及性方面存在差异。然而，2013年至2021年期间，城乡地区在全科医生就诊方面的差异不太明显。
