Associations of Provider-to-Population Ratios and Population Health by County-Level Rurality.
To explore the relationship between provider-to-population ratios, rurality and population health in the United States using counties as the unit of analysis.



Population ratios for registered nurses (RNs), primary care physicians, and dentists were included in multivariable regression analyses. Population health indices assessed were premature death rate, self-rated health, teen birth rate, and mammography screening rate.



County levels of health and health care providers per capita declined as rurality increased. In adjusted regression models, the highest RN-to-population ratio was associated with significantly better health measures in most urban/rural categories, with the magnitude of these associations generally increasing as rurality increased. In the smallest rural counties, the highest RN-to-population quartile was associated with 1,655 fewer years of potential life lost (YPLL), 2% lower rates of poor or fair health, 11/1,000 fewer teen births, and 6% more mammography screening relative to the lowest quartile. For primary care physicians, more significant associations were found in medium and small rural counties where the highest quartile was associated with 1,482 fewer YPLL, 3% lower rates of poor or fair health, 7/1,000 fewer teen births, and 4% more mammography screening. The highest quartile of dentist-to-population ratio was generally associated with lower rates of premature death and poor or fair health in urban, large-, and medium-sized rural counties, but not in small rural counties.



The consistency of the results by provider type suggests that the supply of health care professionals, particularly in rural areas, positively impacts the health of the population.
Betty Irene Moore School of Nursing, University of California, Davis, California.
Bronwyn E
BE
Fields
Betty Irene Moore School of Nursing, University of California, Davis, California.
Jeri L
JL
Bigbee
Betty Irene Moore School of Nursing, University of California, Davis, California.
Janice F
JF
Bell
D003153:Community Health Services / Q000458:organization & administration; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006302:Health Services Research; D006801:Humans; D008297:Male; D000075485:Population Health / Q000706:statistics & numerical data*; D019035:Rural Health Services / Q000458:organization & administration*; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014481:United States; D000078329:Workforce
access to care; geography; health services research; workforce