title: Changes in age-adjusted mortality rates and disparities for rural physician shortage areas staffed by the National Health Service Corps: 1984-1998.
abstract: OBJECTIVE
  This study assesses whether the National Health Service Corps's legislated goals to see health improve and health disparities lessen are being met in rural health professional shortage areas for a key population health indicator: age-adjusted mortality.
  
  
  METHODS
  In a descriptive study using a pre-post design with comparison groups, the authors calculated age-adjusted mortality rates at baseline (1981-1983) and follow-up (1996-1998) for the populations of 448 rural whole-county health professional shortage areas arrayed into 3 groups based on the number of study years they were staffed by National Health Service Corps physicians, physician assistants, and nurse practitioners (terms of 1 to 7, 8 to 11, and 12 to 15 years). The authors compared changes over time in age-adjusted mortality rates in the 3 county groups that had National Health Service Corps staffing with rate changes in 172 whole-county rural health professional shortage areas and 772 non-health professional shortage area rural counties that had no National Health Service Corps.
  
  
  RESULTS
  At baseline age-adjusted mortality was higher in all 4 health professional shortage area county groups than in the non-health professional shortage area county group. Age-adjusted mortality rates improved with time in all groups, including health professional shortage area counties both with and without National Health Service Corps support, and non-health professional shortage area counties. Essentially, baseline differences in age-adjusted mortality rates between health professional shortage areas and non-health professional shortage area counties did not diminish with time, whether or not there was National Health Service Corps support.
  
  
  CONCLUSIONS
  From the early 1980s through the mid-1990s, the National Health Service Corps's goal to see health improve in rural health professional shortage areas was met, but its goal to diminish geographical health disparities was not. Because age-adjusted mortality rates improved in all county groups, the authors conclude that improvement was likely due to a variety of factors, including decreasing poverty and unemployment rates and increasing primary care physician-to-population ratios, to which the National Health Service Corps may have contributed.
authors.affiliation: Cecil G. Sheps Center for Health Services Research and Department of Family Medicine, University of North Carolina, Chapel Hill, NC 27599, USA. don_pathman@unc.edu
authors.forename: Donald E
authors.initials: DE
authors.lastname: Pathman
authors.forename: George E
authors.initials: GE
authors.lastname: Fryer
authors.forename: Larry A
authors.initials: LA
authors.lastname: Green
authors.forename: Robert L
authors.initials: RL
authors.lastname: Phillips
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D002391:Catchment Area, Health; D005500:Follow-Up Studies; D006297:Health Services Accessibility; D006801:Humans; D008507:Medically Underserved Area; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D009722:Nurse Practitioners / Q000600:supply & distribution; D010823:Physician Assistants / Q000600:supply & distribution; D010821:Physicians, Family / Q000600:supply & distribution; D012111:Residence Characteristics; D012423:Rural Health / Q000639:trends*; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology