Intersection of Living in a Rural Versus Urban Area and Race/Ethnicity in Explaining Access to Health Care in the United States.
To examine whether living in a rural versus urban area differentially exposes populations to social conditions associated with disparities in access to health care.



We linked Medical Expenditure Panel Survey (2005-2010) data to geographic data from the American Community Survey (2005-2009) and Area Health Resource File (2010). We categorized census tracts as rural and urban by using the Rural-Urban Commuting Area Codes. Respondent sample sizes ranged from 49 839 to 105 306. Outcomes were access to a usual source of health care, cholesterol screening, cervical screening, dental visit within recommended intervals, and health care needs met.



African Americans in rural areas had lower odds of cholesterol screening (odds ratio[OR] = 0.37; 95% confidence interval[CI] = 0.25, 0.57) and cervical screening (OR = 0.48; 95% CI = 0.29, 0.80) than African Americans in urban areas. Whites had fewer screenings and dental visits in rural versus urban areas. There were mixed results for which racial/ethnic group had better access.



Rural status confers additional disadvantage for most of the health care use measures, independently of poverty and health care supply.
At the time of study, Julia T. Caldwell was first with the Department of Community Health Sciences at the University of California, Los Angeles (UCLA), Fielding School of Public Health, and then with the Section of Hospital Medicine at the University of Chicago, Chicago, IL. Chandra L. Ford, Steven P. Wallace, and May C. Wang were with the Department of Community Health Sciences at the UCLA Fielding School of Public Health. Lois M. Takahashi was with the UCLA Luskin School of Public Affairs.
Julia T
JT
Caldwell
At the time of study, Julia T. Caldwell was first with the Department of Community Health Sciences at the University of California, Los Angeles (UCLA), Fielding School of Public Health, and then with the Section of Hospital Medicine at the University of Chicago, Chicago, IL. Chandra L. Ford, Steven P. Wallace, and May C. Wang were with the Department of Community Health Sciences at the UCLA Fielding School of Public Health. Lois M. Takahashi was with the UCLA Luskin School of Public Affairs.
Chandra L
CL
Ford
At the time of study, Julia T. Caldwell was first with the Department of Community Health Sciences at the University of California, Los Angeles (UCLA), Fielding School of Public Health, and then with the Section of Hospital Medicine at the University of Chicago, Chicago, IL. Chandra L. Ford, Steven P. Wallace, and May C. Wang were with the Department of Community Health Sciences at the UCLA Fielding School of Public Health. Lois M. Takahashi was with the UCLA Luskin School of Public Affairs.
Steven P
SP
Wallace
At the time of study, Julia T. Caldwell was first with the Department of Community Health Sciences at the University of California, Los Angeles (UCLA), Fielding School of Public Health, and then with the Section of Hospital Medicine at the University of Chicago, Chicago, IL. Chandra L. Ford, Steven P. Wallace, and May C. Wang were with the Department of Community Health Sciences at the UCLA Fielding School of Public Health. Lois M. Takahashi was with the UCLA Luskin School of Public Affairs.
May C
MC
Wang
At the time of study, Julia T. Caldwell was first with the Department of Community Health Sciences at the University of California, Los Angeles (UCLA), Fielding School of Public Health, and then with the Section of Hospital Medicine at the University of Chicago, Chicago, IL. Chandra L. Ford, Steven P. Wallace, and May C. Wang were with the Department of Community Health Sciences at the UCLA Fielding School of Public Health. Lois M. Takahashi was with the UCLA Luskin School of Public Affairs.
Lois M
LM
Takahashi
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D002784:Cholesterol / Q000097:blood; D003729:Dental Care / Q000706:statistics & numerical data; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care; D044469:Racial Groups / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014481:United States; D014505:Urban Population / Q000706:statistics & numerical data*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
D002784:Cholesterol