Rural-urban differences in surgical procedures for Medicare beneficiaries.
OBJECTIVE
To determine whether Medicare beneficiaries in rural areas were less likely to undergo a variety of surgical procedures compared with their urban counterparts.


METHODS
Cross-sectional study of Medicare beneficiaries.


METHODS
Any incidence of the surgical procedures studied.


RESULTS
Compared with urban Medicare beneficiaries, rural Medicare beneficiaries were more likely to undergo a broad array of surgical procedures: 35% more likely for carotid endarterectomy (odds ratio [OR] = 1.35; 95% confidence interval [CI], 1.33-1.38), 32% for lumbar spine fusion (OR = 1.32; 95% CI, 1.29-1.35), 30% for knee replacement surgery (OR = 1.30; 95% CI, 1.28-1.31), 28% for abdominal aortic aneurysm repair (OR = 1.28; 95% CI, 1.24-1.31), 22% for prostatectomy (OR = 1.22; 95% CI, 1.19-1.24), 19% for hip replacement surgery (OR = 1.19; 95% CI, 1.17-1.21), 18% for aortic valve replacement (OR = 1.18; 95% CI, 1.14-1.21), 16% for open reduction and internal fixation of the femur (OR = 1.16; 95% CI, 1.14-1.18), and 15% for appendectomy (OR = 1.15; 95% CI, 1.11-1.19). To determine whether these differences could be explained by known confounding variables, we then used logistic regression to adjust for age, sex, race/ethnicity, median household income, average house value, mean poverty ratio, and state of residence. Rural beneficiaries were still more likely to undergo all of these surgical procedures.


CONCLUSIONS
Medicare beneficiaries living in rural areas were more likely to undergo a broad array of surgical procedures compared with those living in urban areas. While allaying some concern about rural access to surgical procedures, the uniformity of these results raises concern that people living in rural areas may have an overall poorer quality of health.
Division of Rheumatology, Texas Tech University Health Sciences Center, 4800 Alberta Ave, El Paso, TX 79905, USA. mark.francis@ttuhsc.edu
Mark L
ML
Francis
Steven L
SL
Scaife
Whitney E
WE
Zahnd
D000368:Aged; D000369:Aged, 80 and over; D015986:Confounding Factors, Epidemiologic; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D012424:Rural Population / Q000706:statistics & numerical data*; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D014481:United States; D014505:Urban Population / Q000706:statistics & numerical data*; D014600:Utilization Review / Q000706:statistics & numerical data