Rural-urban differences in usual source of care and ambulatory service use - Analyses of national data using urban influence codes
Rural-urban differences in usual source of care and ambulatory service use - Analyses of national data using urban influence codes
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DOI：
10.1097/01.mlr.0000076053.28108.f2
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发表时间：
2003-07-01
期刊：
影响因子：
3
通讯作者：
Fleishman, JA
中科院分区：
文献类型：
--
作者：
Larson, SL;Fleishman, JA
背景。在获得和利用医疗保健方面的城乡差距一直是一个长期关注的焦点。使用九类城市影响代码，本研究考察了居住地与获得和利用流动保健服务之间的关系。研究设计。数据来自1996年进行的医疗支出小组调查。线性和逻辑回归分析评估了县类型与拥有常规护理来源和门诊就诊之间的关系，控制了人口和健康状况措施。完全是农村的县的居民比大城市县的居民更有可能报告有一个常规的护理来源（调整后的OR: 1.98; CI: 1.01, 3.89）。没有1万或更多人口的城市，但毗邻大都市地区的居民也更有可能报告拥有通常的护理来源（调整后的or: 1.92; CI: 1.16, 3.22）。在回归分析中，大多数农村地区的居民报告年度就诊次数较少（B = -2.42, CI: -3.68, -1.32）。结果表明，使用超越大都市和非大都市传统二分法的农村和城市定义可能有助于决策者和研究人员确定在获得和随后利用卫生保健方面存在差异的地方类型。在城市影响编码方案中被定义为完全农村的农村居民可能报告有一个医疗保健提供者，但报告在一年内就诊的次数较少。
BACKGROUND. Rural-urban disparities in access to and utilization of medical care have been a long-standing focus of concern.OBJECTIVE. Using the nine-category Urban Influence Codes, this study examines the relationship between place of residence and having access and utilization of ambulatory health services.RESEARCH DESIGN. Data come from the Medical Expenditure Panel Survey, conducted in 1996. Linear and logistic regression analyses assess the relationship between county type and having a usual source of care and ambulatory visits, controlling for demographic and health status measures.RESULTS. Residents of counties that were totally rural were more likely to report having a usual source of care (adjusted OR: 1.98; CI: 1.01, 3.89) than residents of large metropolitan counties. Residents of places without a city of 10,000 or more, but adjacent to a metropolitan area, were also more likely to report having a usual source of care (adjusted OR: 1.92; CI: 1.16, 3.22). In a regression analysis, residents of the most rural places reported fewer visits during the year (B = -2.42, CI: -3.68, -1.32).CONCLUSIONS. Results suggest that using rural and urban definitions that go beyond the traditional dichotomy of metropolitan and non-metropolitan may assist policymakers and researchers in identifying types of places where there is a disparity in access and subsequent utilization of health care. Rural residents, defined as totally rural in the urban influence coding scheme, may report having a health care provider but report fewer visits to health care providers during a year.