title: Racial and ethnic residential segregation and access to health care in rural areas.
abstract: This study examined the relationship between racial/ethnic residential segregation and access to health care in rural areas. Data from the Medical Expenditure Panel Survey were merged with the American Community Survey and the Area Health Resources Files. Segregation was operationalized using the isolation index separately for African Americans and Hispanics. Multi-level logistic regression with random intercepts estimated four outcomes. In rural areas, segregation contributed to worse access to a usual source of health care but higher reports of health care needs being met among African Americans (Adjusted Odds Ratio [AOR]: 1.42, CI: 0.96-2.10) and Hispanics (AOR: 1.25, CI: 1.05-1.49). By broadening the spatial scale of segregation beyond urban areas, findings showed the complex interaction between social and spatial factors in rural areas.
authors.affiliation: Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, United States; Section of Hospital Medicine, The University of Chicago, Chicago, IL, United States. Electronic address: juliatcaldwell@uchicago.edu.
authors.forename: Julia T
authors.initials: JT
authors.lastname: Caldwell
authors.affiliation: Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, United States.
authors.forename: Chandra L
authors.initials: CL
authors.lastname: Ford
authors.affiliation: Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, United States.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Wallace
authors.affiliation: Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, United States.
authors.forename: May C
authors.initials: MC
authors.lastname: Wang
authors.affiliation: UCLA Luskin School of Public Affairs, Los Angeles, Los Angeles, CA, United States.
authors.forename: Lois M
authors.initials: LM
authors.lastname: Takahashi
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D005006:Ethnicity; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D012111:Residence Characteristics; D019035:Rural Health Services / Q000706:statistics & numerical data*; D000072699:Social Segregation; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014505:Urban Population / Q000706:statistics & numerical data
keywords: Access to health care; Race/ethnicity; Residential segregation; Rural; Urban