title: Health services utilization and cost for at-risk drinkers: rural and urban comparisons.
abstract: OBJECTIVE
  The purpose of this study was to examine differences between healthcare use and associated costs in rural and urban at-risk drinkers.
  
  
  METHODS
  Primary healthcare utilization and cost data were collected from 1995 to 1998 on rural (n = 215) and urban (n = 228) cohorts of drinkers residing in six southeastern states who met criteria for at-risk drinking. Data were obtained through subject interview and from abstracts of medical and pharmacy records.
  
  
  RESULTS
  Overall healthcare costs were not significantly different between the rural and urban cohorts. For subjects who incurred any hospital costs (including emergency room [ER] visits), however, costs were significantly greater (p < .01) for rural patients (median = dollars 2,561) than for urban patients (median = dollars 865). Hospital costs associated with patients' ER visits and any subsequent admissions were also greater (p < .01) for rural patients (median = dollars 1,004) than for urban patients (median = dollars 512). Use of healthcare services was significantly more likely to occur among women (p < .0001), individuals with lower overall self-reported physical health (p < .01) and individuals with health insurance (p < .0001). Among subjects who used healthcare services, greater costs were significantly associated with older age (p < .05), being female (p <.0001), having lower overall physical health (p < .0001) and having health insurance (p < .01).
  
  
  CONCLUSIONS
  While overall healthcare costs are not significantly different between rural and urban residents in this sample of at-risk drinkers, there are some notable differences in the costs associated with inpatient and ER services.
authors.affiliation: Centerfor Health Care Research, 135 Canon Street, Suite 403, PO Box 250837, Charleston, South Carolina 29425, USA. nieterpj@musc.edu
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Nietert
authors.forename: Michael T
authors.initials: MT
authors.lastname: French
authors.forename: Joann
authors.initials: J
authors.lastname: Kirchner
authors.forename: Xiaotong
authors.initials: X
authors.lastname: Han
authors.forename: Brenda M
authors.initials: BM
authors.lastname: Booth
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000191:economics* / Q000453:epidemiology; D015331:Cohort Studies; D003710:Demography; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D006304:Health Status; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014505:Urban Population / Q000706:statistics & numerical data*