title: Do children in rural areas still have different access to health care? Results from a statewide survey of Oregon's food stamp population.
abstract: OBJECTIVE
  To determine if rural residence is independently associated with different access to health care services for children eligible for public health insurance.
  
  
  METHODS
  We conducted a mail-return survey of 10,175 families randomly selected from Oregon's food stamp population (46% rural and 54% urban). With a response rate of 31%, we used a raking ratio estimation process to weight results back to the overall food stamp population. We examined associations between rural residence and access to health care (adjusting for child's age, child's race/ethnicity, household income, parental employment, and parental and child's insurance type). A second logistic regression model controlled for child's special health care needs.
  
  
  RESULTS
  Compared with urban children (reference = 1.00), rural children were more likely to have unmet medical care needs (odds ratio [OR] 1.48, 95% confidence interval [CI] 1.07-2.04), problems getting dental care (OR 1.36, 95% CI 1.03-1.79), and at least one emergency department visit in the past year (OR 1.42, 95% CI 1.10-1.81). After adjusting for special health care needs (more prevalent among rural children), there was no rural-urban difference in unmet medical needs, but physician visits were more likely among rural children. There were no statistically significant differences in unmet prescription needs, delayed urgent care, or having a usual source of care.
  
  
  CONCLUSIONS
  These findings suggest that access disparities between rural and urban low-income children persist, even after adjusting for health insurance. Coupled with continued expansions in children's health insurance coverage, targeted policy interventions are needed to ensure the availability of health care services for children in rural areas, especially those with special needs.
authors.affiliation: Department of Family Medicine, Oregon Health and Science University, Portland, Oregon 97239, USA. devoej@ohsu.edu
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: DeVoe
authors.forename: Lisa
authors.initials: L
authors.lastname: Krois
authors.forename: Rob
authors.initials: R
authors.lastname: Stenger
mesh_terms: D000293:Adolescent; D000385:Aid to Families with Dependent Children / Q000706:statistics & numerical data*; D002648:Child; D002662:Child Health Services / Q000191:economics / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003266:Continuity of Patient Care; D019988:Children with Disabilities / Q000706:statistics & numerical data; D005522:Food Services; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D016015:Logistic Models; D009922:Oregon; D019035:Rural Health Services / Q000191:economics / Q000706:statistics & numerical data*; D014481:United States; D019037:Urban Health Services / Q000191:economics / Q000706:statistics & numerical data; D035862:Vulnerable Populations / Q000706:statistics & numerical data