title: Rural/urban differences in access to and utilization of services among people in Alabama with sickle cell disease.
abstract: OBJECTIVE
  This study examined relationships between socioeconomic factors and the geographic distribution of 662 cases of sickle cell disease in Alabama in 1999-2001.
  
  
  METHODS
  Measures of community distress, physical functioning, and medical problems were used in analyzing utilization differences between individuals with sickle cell disease living in urban and rural areas.
  
  
  RESULTS
  Utilization of comprehensive sickle cells disease services was lower for individuals with sickle cell disease living in rural areas than for those living in urban areas. Rural clients reported significantly more limitations than urban clients on several measures of physical functioning. The results also suggest that utilization of services was higher for those with more medical problems and those who lived in high distress areas, although these findings did not meet the criterion for statistical significance.
  
  
  CONCLUSIONS
  Conclusions based on statistical evidence that geographic location and socioeconomic factors relate to significantly different health care service experience bear important implications for medical and health care support systems, especially on the community level.
authors.affiliation: Department of Maternal and Child Health, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35292, USA. jtelfair@uab.edu
authors.forename: Joseph
authors.initials: J
authors.lastname: Telfair
authors.forename: Akhlaque
authors.initials: A
authors.lastname: Haque
authors.forename: Marc
authors.initials: M
authors.lastname: Etienne
authors.forename: Shenghui
authors.initials: S
authors.lastname: Tang
authors.forename: Sheryl
authors.initials: S
authors.lastname: Strasser
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000407:Alabama / Q000453:epidemiology; D000755:Anemia, Sickle Cell / Q000453:epidemiology* / Q000208:ethnology / Q000503:physiopathology; D019352:Censuses; D002648:Child; D006297:Health Services Accessibility / Q000145:classification / Q000706:statistics & numerical data*; D006801:Humans; D019035:Rural Health Services / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D019037:Urban Health Services / Q000706:statistics & numerical data*