Are rural residents less likely to obtain recommended preventive healthcare services?

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Abstract

Background: This study examined rural-urban differences in utilization of preventive healthcare services and assessed the impact of rural residence, demographic factors, health insurance status, and health system characteristics on the likelihood of obtaining each service.

Methods: National data from the 1997 Behavioral Risk Factor Surveillance System (BRFSS) and the 1999 Area Resource File were used to evaluate the adequacy of preventive services obtained by rural and urban women and men, using three sets of nationally accepted preventive services guidelines from the American Cancer Society, U.S. Preventive Services Task Force, and Healthy People 2010. Logistic regression models were developed to control for the effect of demographic factors, health insurance status, and health system characteristics.

Results: Rural residents are less likely than urban residents to obtain certain preventive health services and are further behind urban residents in meeting Healthy People 2010 objectives.

Conclusions: Efforts to increase rural preventive services utilization need to build on federal, state, and community-based initiatives and to recognize the special challenges that rural areas present.

Introduction

Underutilization of preventive healthcare services may result in a failure to identify healthcare problems that might be successfully managed with medication or lifestyle changes, as well as missed opportunities to prevent potentially life-threatening diseases. Failure to obtain timely screening tests for certain cancers may result in diagnosis at later stages of the disease, when the prognosis is poorer. Low incomes, less education, lack of health insurance that covers preventive services, lack of knowledge about the potential benefits of preventive services, not having a regular source of medical care, and residing at a distance from medical care are associated with low utilization of preventive services.1, 2, 3, 4, 5

Rural populations generally have lower incomes and less education, are more likely to be uninsured, and have longer travel times to their usual source of medical care than urban populations.6, 7 Surveys and focus groups of rural residents have identified several barriers to obtaining preventive healthcare services, including cost, lack of insurance coverage, travel distance, transportation problems, difficulty taking time off at work, and lack of recommendations regarding the need for the preventive service from a healthcare provider.8, 9, 10, 11, 12, 13

Previous research quantifying the relationship between rural residence and preventive care utilization has been limited. Cancer tends to be diagnosed at more advanced stages among rural populations, suggesting that rural residents are less likely to receive timely cancer screening tests.14, 15 Rural residence has been found to be a strong predictor of mammography underuse.16, 17 However, residence in a rural area was not related to receipt of pneumonia and influenza vaccines by the elderly.18

The purpose of this study is to describe the utilization of specific preventive healthcare services by rural women and men, and to assess the impact of rural residence, the availability of healthcare providers and technology, demographic factors, and health insurance status on the likelihood of obtaining recommended screening tests for colon, cervical, and breast cancer and recommended vaccinations for influenza and pneumonia.

Section snippets

Sample

The study used data from the 1997 Behavioral Risk Factor Surveillance System (BRFSS), a state-based phone survey of the U.S. non-institutionalized adult population, and the 1999 Area Resource File (ARF). Through the BRFSS, the Centers for Disease Control and Prevention and the states collect data annually on preventive health practices and risk behaviors. The ARF database provides county-level data on the availability of healthcare providers and technology.

Most previous analyses of BRFSS

Results

Table 2 displays the proportion of urban, rural adjacent, and rural non-adjacent women and men that received each recommended service; it also summarizes the results of the comparisons between urbanicity categories and, where relevant, by gender. Nearly all groups fell far short of receiving recommended levels of preventive services; the proportion of persons receiving colon cancer screening tests was especially low. By urbanicity category, the percentage differences in service use were

Discussion

The results of this study indicate that rural residents are significantly less likely than urban residents to obtain certain preventive health services in the time frame recommended by nationally accepted guidelines (even after controlling for demographic characteristics, health insurance status, and healthcare market characteristics) and further behind in meeting the Healthy People 2010 national health promotion and disease prevention objectives.

Influenza and pneumonia vaccinations for persons

Acknowledgements

Support for this study was provided by the Office of Rural Health Policy, Health Resources and Services Administration, PHS Grant No. CSRUC 0002-03. Joan Van Nostrand, three anonymous reviewers, and the editorial board of the American Journal of Preventive Medicine provided helpful comments on an earlier version of this article.

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