The influence of rurality on the volume of non-urgent emergency department visits.

At least one-third of emergency department (ED) visits in the United States are non-urgent, for conditions that can be treated more efficiently in primary care settings. Research suggests rural areas may have higher non-urgent ED visit rates. Such research rarely accounts for spatial factors that may bias results, and is often limited to dichotomous rurality measures, either "rural" or "urban". We examined the association between multiple levels of rurality and ED visits in South Carolina. Controlling for spatial effects, the distance of Community Health Centers from the cores of populated areas (centroids), and the percentage of the population in poverty, increasing levels of rurality predicted higher rates of uninsured ED visits, non-urgent ED visits, non-urgent privately insured ED visits, and non-urgent uninsured ED visits. Results also demonstrated that estimates of effects of rurality on ED use that do not account for spatial random effects would be biased.