Journal of Rural Health
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Is Travel Time to Colonoscopy Associated With Late‐Stage Colorectal Cancer Among Medicare Beneficiaries in Iowa?Abstract Background Colorectal cancer (CRC) screening has been shown to decrease the incidence of late‐stage colorectal cancer, yet a substantial proportion of Americans do not receive screening. Those in rural areas may face barriers to colonoscopy services based on travel time, and previous studies have demonstrated lower screening among rural residents. Our purpose was to assess factors associated with late‐stage CRC, and specifically to determine if longer travel time to colonoscopy was associated with late‐stage CRC among an insured population in Iowa. Methods SEER‐Medicare data were used to identify individuals ages 65 to 84 years old diagnosed with CRC in Iowa from 2002 to 2009. The distance between the centroid of the ZIP code of residence and the ZIP code of colonoscopy was computed for each individual who had continuous Medicare fee‐for‐service coverage for a 3‐ to 4‐month period prior to diagnosis, and a professional claim for colonoscopy within that time frame. Demographic characteristics and travel times were compared between those diagnosed with early‐ versus late‐stage CRC. Also, demographic differences between those who had colonoscopy claims identified within 3‐4 months prior to diagnosis (81%) were compared to patients with no colonoscopy claims identified (19%). Results A total of 5,792 subjects met inclusion criteria; 31% were diagnosed with early‐stage versus 69% with late‐stage CRC. Those divorced or widowed (vs married) were more likely to be diagnosed with late‐stage CRC (OR: 1.20, 95% CI: 1.06‐1.37). Travel time was not associated with diagnosis of late‐stage CRC. Discussion Among a Medicare‐insured population, there was no relationship between travel time to colonoscopy and disease stage at diagnosis. It is likely that factors other than distance to colonoscopy present more pertinent barriers to screening in this insured population. Additional research should be done to determine reasons for nonadherence to screening among those with access to CRC screening services, given that over two‐thirds of these insured individuals were diagnosed with late‐stage CRC.
Journal of Rural Health - Tập 32 Số 4 - Trang 363-373 - 2016
Urban, Rural, and Regional Variations in Physical Activity
Journal of Rural Health - Tập 21 Số 3 - Trang 239-244 - 2005
The Role of Race and Residence in Determining Stage at Diagnosis of Breast CancerABSTRACT: 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
Journal of Rural Health - Tập 13 Số 2 - Trang 99-108 - 1997
Accessibility Assessment of the Health Care Improvement Program in Rural Taiwan
Journal of Rural Health - Tập 21 Số 4 - Trang 372-377 - 2005
Do Older Rural and Urban Veterans Experience Different Rates of Unplanned Readmission to VA and Non‐VA Hospitals?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.
Journal of Rural Health - Tập 25 Số 1 - Trang 62-69 - 2009
Veterans Health Administration and Medicare Outpatient Health Care Utilization by Older Rural and Urban New England VeteransABSTRACT: 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.
Journal of Rural Health - Tập 21 Số 2 - Trang 167-171 - 2005
Birth Outcomes Among Older Mothers in Rural Versus Urban Areas: A Residence-Based Approach
Journal of Rural Health - Tập 27 Số 2 - Trang 211-219 - 2011
Examining Rural/Urban Differences in Prescription Opioid Misuse Among US AdolescentsAbstract Purpose This 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. Methods We 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. Results Among 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. Conclusions Researchers, 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.
Journal of Rural Health - Tập 32 Số 2 - Trang 204-218 - 2016
Quality of End‐of‐Life Care Among Rural Medicare Beneficiaries With Colorectal CancerAbstract Background Although 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. Methods Medicare 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. Results About 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. Conclusions Evidence 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.
Journal of Rural Health - Tập 30 Số 4 - Trang 397-405 - 2014
Rural‐Urban Differences in Costs of End‐of‐Life Care for Elderly Cancer Patients in the United StatesAbstract Purpose The objective of this study was to examine the rural‐urban differences in Medicare expenditures on end‐of‐life care for elderly cancer patients in the United States. Methods We analyzed Medicare claims data for 175,181 elderly adults with lung, colorectal, female breast, or prostate cancer diagnosis who died in 2008. The end‐of‐life costs were quantified as total Medicare expenditures for the last 12 months of care including inpatient, outpatient, physician services, hospice, home health, skilled nursing facilities (SNF), and durable medical expenditure. Linear regression models were used to estimate rural‐urban differences in log‐transformed end‐of‐life costs and logistic regressions were used to estimate probability of service use, adjusting for demographics, socioeconomic status, and comorbidities. Findings On average, elderly cancer patients cost Medicare $51,273, $50,274, $62,815, and $50,941 in the last year for breast, prostate, colorectal, and lung cancer, respectively. Rural patients cost Medicare about 10%, 6%, 8%, and 4% less on end‐of‐life care than their urban counterparts for breast, prostate, colorectal, and lung cancer, respectively. Rural cancer patients were less likely to use hospice and home health, more likely to use outpatient and SNF, and they cost Medicare less on inpatient and physician services and more on outpatient care conditional on service use. Conclusions The lower Medicare spending on end‐of‐life care for the rural cancer patients suggests disparities based on place of residence. A future study that delineates the source of the rural‐urban difference can help us understand whether it indicates inappropriate level of palliative care and find effective policies to reduce the urban‐rural disparities.
Journal of Rural Health - Tập 32 Số 4 - Trang 353-362 - 2016
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