ArticlePloS one2022
Quantifying rural disparity in healthcare utilization in the United States: Analysis of a large midwestern healthcare system.
Article in PloS one, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 40 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
40 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Post-Acute Care Trends and Disparities After Joint Replacements in the United States, 1991-2018: A Systematic Review.Journal of the American Medical Directors Association · 2024Pooled it
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- Prospective User Perceptions and Acceptability of a Wearable Fetal Heart Monitor: Cross-Sectional Survey.JMIR formative research · 2026Article
- Access to Care and Self-Rated Health Status: Comparison of Rural and Urban Immigrants in the US.Journal of immigrant and minority health · 2026Article
- Comparing Trends in Telemedicine Use and Geographic Disparities in Utilization Among Patients With Cancer in the United States.JCO oncology practice · 2026Article
- Addressing Access Barriers in Rural America: A Mixed-Methods Study of Wisconsin's Family Resource Centers.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2026Article
- Cost and Utilization of Ambulance Services Across the United States.Healthcare (Basel, Switzerland) · 2026Article
- Socioeconomic determinants of COVID-19 incidence in a German rural area.BMC public health · 2026Article
- Missingness in the National Cancer Database: A Novel Surrogate for Hepatobiliary Cancer Outcomes.Annals of surgical oncology · 2026Article
- Implementation outcomes of video-observed oral fluid self-collection for drug testing in substance use disorder treatment: a pilot study.Frontiers in public health · 2026Article
- Effect of Regional Deprivation and Dental Care Resources on the Unmet Dental Care Needs due to Cost of Older Individuals in South Korea.Gerodontology · 2025Article
- PRICE: a personalized recursive intelligent cost effectiveness analysis framework for rare disease diagnosis.BMC medical informatics and decision making · 2025Article
- Integrated approaches to reduce alcohol use in people with liver disease: a scoping review and quantitative analysis.Alcohol and alcoholism (Oxford, Oxfordshire) · 2025Article
- Trends in mortality from pulmonary hypertension amongst population with congenital heart disease in the United States from 1999 to 2020: A CDC WONDER analysis.International journal of cardiology. Congenital heart disease · 2025Article
- Beliefs regarding nicotine replacement therapy among rural residing people who smoke: a step towards promoting uptake.Preventive medicine reports · 2025Article
- High Users of Primary Care Secure Messaging in the Veterans Health Administration.Annals of family medicine · 2025Article
- The role of veterans hospitals in Taiwan's medically underserved areas.Journal of the Chinese Medical Association : JCMA · 2025Article
- Neighborhood Determinants of Primary Care Access in Virginia.Annals of family medicine · 2025Article
- Rural nonprofit hospital community benefit and financial assistance spending: A call for greater reporting transparency.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2025Article
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Authors and funding
9 authors.
Funding
Abstract
purposeThe objective of this study is to identify how predisposing characteristics, enabling factors, and health needs are jointly and individually associated with epidemiological patterns of outpatient healthcare utilization for patients who already interact and engage with a large healthcare system.
methodsWe retrospectively analyzed electronic medical record data from 1,423,166 outpatient clinic visits from 474,674 patients in a large healthcare system from June 2018-March 2019. We evaluated patients who exclusively visited rural clinics versus patients who exclusively visited urban clinics using Chi-square tests and the generalized estimating equation Poisson regression methodology. The outcome was healthcare use defined by the number of outpatient visits to clinics within the healthcare system and independent variables included age, gender, race, ethnicity, smoking status, health status, and rural or urban clinic location. Supplementary analyses were conducted observing healthcare use patterns within rural and urban clinics separately and within primary care and specialty clinics separately.
findingsPatients in rural clinics vs. urban clinics had worse health status [χ2 = 935.1, df = 3, p<0.0001]. Additionally, patients in rural clinics had lower healthcare utilization than patients in urban clinics, adjusting for age, race, ethnicity, gender, smoking, and health status [2.49 vs. 3.18 visits, RR = 0.61, 95%CI = (0.55,0.68), p<0.0001]. Further, patients in rural clinics had lower utilization for both primary care and specialty care visits.
conclusionsWithin the large healthcare system, patients in rural clinics had lower outpatient healthcare utilization compared to their urban counterparts despite having potentially elevated health needs reflected by a higher number of unique health diagnoses documented in their electronic health records after adjusting for multiple factors. This work can inform future studies exploring the roots and ramifications of rural-urban healthcare utilization differences and rural healthcare disparities.
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