New Study Reveals Disparities Between Rural and Urban Healthcare Utilization

Rural road with flowers and a tree

According to a new study published in Plos One, rural patients access healthcare services less than their urban counterparts, despite having more health concerns.

Dr. Tim Baker
UW-CTRI Research Director Dr. Tim Baker

“There is increasing evidence that rural residents are both sicker than non-rural residents but also use healthcare less frequently,” said Dr. Timothy Baker, UW-CTRI Research Director who collaborated with Li-Shiun Chen, Laura Bierut, Akua Nuako, and other researchers at Washington University in St. Louis on this project.

“The growing evidence and awareness of the relationship between rural location and health status increased our interest in exploring this issue. Further, the availability of electronic health record data offered a different approach to studying this issue. Much prior research in this area used population-based surveys. Both methods are valid approaches but using both should produce complementary information.”

Researchers analyzed the electronic health records of over 470,000 patients across almost 1.5 million clinics, focusing on primary and specialty care outpatient visits. Their goal? Identify disparities between urban and rural healthcare utilization.

They confirmed that rural patients were sicker than urban patients—they had more health conditions and worse health status—but they also found that, across all demographics, those same rural patients were accessing outpatient care less frequently.

“I thought it was noteworthy that the rural vs. non-rural disparity remained when controlling for multiple patient characteristics,” said Baker. “The disparity seemed to be quite general, occurring across multiple demographics.

“We hope to explore different healthcare-delivery strategies as means of mitigating the healthcare utilization disparity that exists. For instance, we are interested in how smoking treatment can be delivered so that it achieves significantly greater reach in rural populations.

“The current research also argues for more fine-grained analyses of rural vs. non-rural disparities; to what extent is it related to insurance status, economic status, transportation access, educational status, and so on?”

Nuako A, Liu J, Pham G, Smock N, James A, Baker TB, Bierut L, Colditz G, Chen L-S. (2022) Quantifying Rural Disparity in Healthcare Utilization in the United States: Analysis of a Large Midwestern Healthcare System. PLOS One. Online February 10, 2022.