Diagnosed mental and physical health conditions in the United States nursing home population: differences between urban and rural facilities.
BACKGROUND
There has been limited examination of the differences in health characteristics of the rural long-term care population. Recognizing these differences will allow policymakers to improve access to long-term care services in rural communities.


OBJECTIVE
To determine whether differences in likelihood of diagnosis exist between urban and rural nursing home residents for 8 common medical conditions: 4 mental health conditions (depression, anxiety, Alzheimer's, and non-Alzheimer's dementia) and 4 physical health conditions (cancer, emphysema/chronic obstructive pulmonary disease, heart disease, and stroke/transient ischemic attack).


METHODS
We used multivariate logistic regression to examine data derived from the 1996 Nursing Home Component of the Medical Expenditure Panel Survey, a multistage stratified probability sample of 815 nursing homes and 5899 residents, representing 3.1 million individuals in the United States who spent 1 or more nights in nursing homes during 1996.


RESULTS
Residents in rural homes were less likely to be diagnosed with depression compared to those in homes in large metropolitan areas, and residents in homes in small metropolitan areas were less likely to have cancer than those in large metropolitan areas. Diagnostic status between urban and rural residents was comparable for the other 6 conditions.


CONCLUSIONS
Further research is necessary to determine whether and why depression is inadequately diagnosed in rural nursing homes and to ascertain which types of cancer are responsible for the observed differential. Such research is particularly important for elderly nursing home residents who are more likely to suffer from chronic conditions that require significant medical supervision.
Dobalian
Aram
A
Department of Health Services Administration, University of Florida, PO Box 100195, Gainesville, FL 32610-0195, USA. adobalia@hp.ufl.edu
Tsao
Jennie C I
JC
Radcliff
Tiffany A
TA
D000368:Aged; D003704:Dementia / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology; D005260:Female; D006304:Health Status; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000453:epidemiology; D009735:Nursing Homes / Q000706:statistics & numerical data*; D012423:Rural Health / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D014504:Urban Health / Q000706:statistics & numerical data*