Kenton J Johnston1, Hefei Wen2, Ameya Kotwal3, Karen E Joynt Maddox4. 1. Department of Health Management and Policy and Center for Outcomes Research, College for Public Health and Social Justice, Saint Louis University , 3545 Lafayette Ave., Room 362, St. Louis, MO, 63104, USA. johnstonkj@slu.edu. 2. Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute , 401 Park Drive, Suite 401 East, Boston, MA, 02215, USA. 3. Department of Health Management and Policy, College for Public Health and Social Justice, Saint Louis University , 3545 Lafayette Ave, St. Louis, MO, 63104, USA. 4. Cardiovascular Division, Washington University School of Medicine , 660 S. Euclid Ave, CB 8086, St. Louis, MO, 63110, USA.
Abstract
BACKGROUND: Rural Americans have less access to care than urban Americans. Preventable acute care use is a marker of unmet ambulatory healthcare needs, but little is known about how such utilization has differed between rural and urban areas over time. OBJECTIVE: Compare preventable emergency department (ED) visit and hospitalization rates among rural versus urban residents over the past decade. DESIGN: Observational study using a validated algorithm to compute age-sex-adjusted rates per 100,000 individuals of preventable ED visits and hospitalizations. Differences in overall, annual, and condition-specific rates for rural versus urban residents were assessed and linear regression was used to assess 10-year trends. SETTING: Nationwide Emergency Department Sample, National Inpatient Sample, and US Census, 2008-2017. PARTICIPANTS: US adults, an annual average of 241.3 million individuals. MEASUREMENTS: Preventable ED visits and hospitalizations. RESULTS: Compared to urban residents, rural residents had 45% higher rates of preventable ED visits in 2008 (3003 vs. 2070 per 100,000, adjusted difference [AD]: 933; 95% CI: 928-938) and 44% higher rates of preventable ED visits in 2017 (3911 vs. 2708 per 100,000, AD: 1202; 95% CI: 1196-1208). Rural residents had 26% higher rates of preventable hospitalizations in 2008 (2104 vs. 1666 per 100,000, AD: 439; 95% CI: 434-443) and 13% higher rates in 2017 (1634 vs. 1440 per 100,000, AD: 194; 95% CI: 190-199). Preventable ED visits increased more in absolute terms in rural versus urban residents, but the percentage increase was similar (30% vs. 31%) because rural residents started at a higher baseline. Preventable hospitalizations decreased at a faster rate (22% vs. 14%) among rural versus urban residents. LIMITATIONS: Observational study; unable to infer causality. CONCLUSIONS: Rural disparities in acute care use are narrowing for preventable hospitalizations but have persisted for all preventable acute care use, suggesting unmet demand for high-quality ambulatory care in rural areas.
BACKGROUND: Rural Americans have less access to care than urban Americans. Preventable acute care use is a marker of unmet ambulatory healthcare needs, but little is known about how such utilization has differed between rural and urban areas over time. OBJECTIVE: Compare preventable emergency department (ED) visit and hospitalization rates among rural versus urban residents over the past decade. DESIGN: Observational study using a validated algorithm to compute age-sex-adjusted rates per 100,000 individuals of preventable ED visits and hospitalizations. Differences in overall, annual, and condition-specific rates for rural versus urban residents were assessed and linear regression was used to assess 10-year trends. SETTING: Nationwide Emergency Department Sample, National Inpatient Sample, and US Census, 2008-2017. PARTICIPANTS: US adults, an annual average of 241.3 million individuals. MEASUREMENTS: Preventable ED visits and hospitalizations. RESULTS: Compared to urban residents, rural residents had 45% higher rates of preventable ED visits in 2008 (3003 vs. 2070 per 100,000, adjusted difference [AD]: 933; 95% CI: 928-938) and 44% higher rates of preventable ED visits in 2017 (3911 vs. 2708 per 100,000, AD: 1202; 95% CI: 1196-1208). Rural residents had 26% higher rates of preventable hospitalizations in 2008 (2104 vs. 1666 per 100,000, AD: 439; 95% CI: 434-443) and 13% higher rates in 2017 (1634 vs. 1440 per 100,000, AD: 194; 95% CI: 190-199). Preventable ED visits increased more in absolute terms in rural versus urban residents, but the percentage increase was similar (30% vs. 31%) because rural residents started at a higher baseline. Preventable hospitalizations decreased at a faster rate (22% vs. 14%) among rural versus urban residents. LIMITATIONS: Observational study; unable to infer causality. CONCLUSIONS: Rural disparities in acute care use are narrowing for preventable hospitalizations but have persisted for all preventable acute care use, suggesting unmet demand for high-quality ambulatory care in rural areas.
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