Examining Rural/Urban Differences in Prescription Opioid Misuse Among US Adolescents Tập 32 Số 2 - Trang 204-218 - 2016
Shannon M. Monnat, Khary K. Rigg
AbstractPurposeThis study examines differences in prescription opioid misuse (POM) among adolescents in rural, small urban, and large urban areas of the United States and identifies several individual, social, and community risk factors contributing to those differences.
MethodsWe used nationally representative data from the 2011 and 2012 National Survey on Drug Use and Health and estimated binary logistic regression and formal mediation models to assess past‐year POM among 32,036 adolescents aged 12‐17.
ResultsAmong adolescents, 6.8% of rural, 6.0% of small urban, and 5.3% of large urban engaged in past‐year POM. Net of multiple risk and protective factors, rural adolescents have 35% greater odds and small urban adolescents have 21% greater odds of past‐year POM compared to large urban adolescents. The difference between rural and small urban adolescents was not significant. Criminal activity, lower perceived substance use risk, and greater use of emergency medical treatment partially contribute to higher odds among rural adolescents, but they are also partially buffered by less peer substance use, less illicit drug access, and stronger religious beliefs.
ConclusionsResearchers, policy makers, and treatment providers must consider the complex array of individual, social, and community risk and protective factors to understand rural/urban differences in adolescent POM. Potential points of intervention to prevent POM in general and reduce rural disparities include early education about addiction risks, use of family drug courts to link criminal offenders to treatment, and access to nonemergency medical services to reduce rural residents’ reliance on emergency departments where opioid prescribing is more likely.
Veterans Health Administration and Medicare Outpatient Health Care Utilization by Older Rural and Urban New England Veterans Tập 21 Số 2 - Trang 167-171 - 2005
William B. Weeks, David M. Bott, Rebecca P. Lamkin, Steven M. Wright
ABSTRACT: Context: Older veterans often use both the Veterans Health Administration (VHA) and Medicare to obtain health care services. Purpose: The authors sought to compare outpatient medical service utilization of Medicare‐enrolled rural veterans with their urban counterparts in New England. Methods: The authors combined VHA and Medicare databases and identified veterans who were age 65 and older and enrolled in Medicare fee‐for‐service plans, and they obtained records of all their VHA services in New England between 1997 and 1999. The authors used ZIP codes to designate rural or urban residence and categorized outpatient utilization into primary care, individual mental health care, non–mental health specialty care, or emergency room care. Findings: Compared with their urban counterparts, veterans living in rural settings used significantly fewer VHA and Medicare‐funded primary care, specialist care, and mental health care visits in all 3 years examined (P<.001 for all). Compared with urban veterans, veterans living in rural settings used fewer VHA emergency department services in 1998 and 1999 but more Medicare‐funded emergency department visits in 1997. The authors found some evidence of substitution of Medicare for VHA emergency visits in rural veterans, but no other evidence of like‐service substitution. Rural veterans were more reliant on Medicare for primary care and on VHA services for specialty and mental health care. Conclusions: These findings suggest that rural access to federally funded health care is restricted relative to urban access. Older veterans may choose different systems of care for different health care services. With poor access to primary care, rural veterans may substitute emergency room visits for routine care.
The Role of Race and Residence in Determining Stage at Diagnosis of Breast Cancer Tập 13 Số 2 - Trang 99-108 - 1997
Cheryl H. Amey, Michael K. Miller, Stan L. Albrecht
ABSTRACT: Breast cancer kills more than 46,000 women each year. Previous research has found that minorities and those who reside in geographically remote settings are particularly vulnerable. However, virtually no research has been done on the potential “double jeopardy” faced by rural minority women. This research examines (1) the extent to which racial and residential differences contribute to differences in stage at diagnosis; (2) the existence of an interaction between race and residence, which may place black rural women at greater risk; and (3) the influence of both individual and structural characteristics on racial and residential differences. The findings indicate that rural black women are diagnosed with breast cancer much later than are black urban women or whites of either residence. A number of individual and structural variables were influential in predicting stage at diagnosis, yet none of these accounted entirely for racial differences
Do Older Rural and Urban Veterans Experience Different Rates of Unplanned Readmission to VA and Non‐VA Hospitals? Tập 25 Số 1 - Trang 62-69 - 2009
William B. Weeks, Richard E. Lee, Amy E. Wallace, Alan N. West, James P. Bagian
ABSTRACT:
Context: Unplanned readmission within 30 days of discharge is an indicator of hospital quality. Purpose: We wanted to determine whether older rural veterans who were enrolled in the VA had different rates of unplanned readmission to VA or non‐VA hospitals than their urban counterparts. Methods: We used the combined VA/Medicare dataset to examine 3,513,912 hospital admissions for older veterans that occurred in VA or non‐VA hospitals between 1997 and 2004. We calculated 30‐day readmission rates and odds ratios for rural and urban veterans, and we performed a logistic regression analysis to determine whether living in a rural setting or initially using the VA for hospitalization were independent risk factors for unplanned 30‐day readmission, after adjusting for age, sex, length of stay of the index admission, and morbidity. Findings: Overall, rural veterans had slightly higher 30‐day readmission rates than their urban counterparts (17.96% vs 17.86%; OR 1.006, 95% CI: 1.0004, 1.013). For both rural‐ and urban‐dwelling veterans, readmission after using a VA hospital was more common than after using a non‐VA hospital (20.7% vs 16.8% for rural veterans, 21.2% vs 16.1% for urban veterans). After adjusting for other variables, readmission was more likely for rural veterans and following admission to a VA hospital. Conclusions: Our findings suggest that VA should consider using the unplanned readmission rate as a performance metric, using the non‐VA experience of veterans as a performance benchmark, and helping rural veterans select higher performing non‐VA hospitals.
Birth Volume and the Quality of Obstetric Care in Rural Hospitals Tập 30 Số 4 - Trang 335-343 - 2014
Katy B. Kozhimannil, Peiyin Hung, Shailendra Prasad, Michelle Casey, Maeve McClellan, Ira Moscovice
AbstractBackgroundChildbirth is the most common reason for hospitalization in the United States. Assessing obstetric care quality is critically important for patients, clinicians, and hospitals in rural areas.
MethodsThe study used hospital discharge data from the Statewide Inpatient Databases, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, for 9 states (Colorado, Iowa, Kentucky, New York, North Carolina, Oregon, Vermont, Washington, and Wisconsin) to identify all births in rural hospitals with 10 or more births/year in 2002 (N = 94,356) and 2010 (N = 103,880). Multivariate logistic regression was used to assess the relationship between hospital annual birth volume, measured as low (10‐110), medium (111‐240), medium‐high (241‐460) or high (>460), and 3 measures of obstetric care quality (low‐risk cesarean rates for term, vertex, and singleton pregnancies with no prior cesarean; nonindicated cesarean; and nonindicated induction) and 2 patient safety measures (episiotomy and perineal laceration).
ResultsThe odds of low‐risk and nonindicated cesarean were lower in medium‐high and high‐volume rural hospitals compared with low‐volume hospitals after controlling for maternal demographic and clinical factors. In low‐volume hospitals, odds of labor induction without medical indication were higher than in medium‐volume hospitals, but not significantly different from medium‐high or high‐volume hospitals. Odds of episiotomy were greater in medium‐high or high‐volume hospitals than in low‐volume hospitals. The likelihood of perineal laceration did not differ significantly by birth volume.
ConclusionsObstetric quality and safety outcomes vary significantly across rural hospitals by birth volume. Better performance is not consistently associated with either lower or higher volume facilities.
Quality of End‐of‐Life Care Among Rural Medicare Beneficiaries With Colorectal Cancer Tập 30 Số 4 - Trang 397-405 - 2014
Shinobu Watanabe‐Galloway, Wanqing Zhang, Kate Watkins, KM Monirul Islam, Preethy Nayar, Eugene Boilesen, Lina Lander, Hongmei Wang, Fang Qiu
AbstractBackgroundAlthough previous research has documented rural disparities in hospice use, limited data exist on the roles of geographic access in different types of end‐of‐life indicators among cancer survivors.
MethodsMedicare claims data were used to identify beneficiaries with colorectal cancer who died in 2008 (N = 34,975). We evaluated rural‐urban differences in ER visits 90 days before death, inpatient hospital admissions ≤90 days before death, intensive care unit (ICU) use ≤90 days before death, hospice care use at any time, and hospice enrollment <3 days before death.
ResultsAbout 60% of beneficiaries in rural areas lived in counties with the 2 lowest socioecomonic levels compared to only 5.3% of beneficiaries in metropolitan areas. After adjusting for demographic factors and comorbidities, beneficiaries in rural counties had a lower number of ICU days (RR = 0.65) and were less likely to ever use hospice (OR = 0.78) compared to those in metropolitan counties. Beneficiaries from racial/ethnic minority groups, those with lower socioeconomic status, and those with a higher comorbidity index were less likely to ever use hospice but they tended to use ER, inpatient care, and ICU.
ConclusionsEvidence for disparities due to geographic access and socioeconomic factors warrant increased efforts to remove systemic and structural barriers. Future research should focus on exploring and evaluating potential policy and practice interventions to improve the quality of life among elderly cancer survivors living in rural communities and those from socioeconomically disadvantaged backgrounds.
