Rural and Underserved Health Research Center: Rural Health Research Products & Journal Articles

2024

Cervical Cancer Screening Rates Among Rural and Urban Females, From 2019 to 2022
Journal Article
Date: 06/2024
This study examines the receipt of a Papanicolaou test in the past year among U.S. females overall and females residing in rural and urban areas in 2019, 2020, and 2022, using the Health Information National Trends Survey.
Discussions of Cancer Survivorship Care Needs: Are There Rural Versus Urban Inequities?
Journal Article
Date: 05/2024
This study used 2017 Medical Expenditure Panel Survey data to test for rural versus urban inequities and identify other correlates of discussions about cancer survivorship care with health care professionals.
Satisfaction With Care Among Cancer Survivors With Medicare Coverage: Are There Rural vs. Urban Inequities?
Journal Article
Date: 03/2024
This article examines satisfaction with health care among rural vs urban Medicare cancer survivors. Researchers looked at nine dimensions of health care and tested for rural/urban differences, adjusting for demographic factors, health insurance, and self-rated health.
Suicide Rates and Risks Across U.S. Industries: A 29-Year Population-Based Survey
Journal Article
Date: 01/2024
Combining 29 years of U.S. suicide data using the National Health Interview Survey (NHIS)-Mortality Linked data from 1986 through 2014, with mortality follow-up through 2015, this study estimates suicide risks across industries in the U.S. working population.

2023

Addressing Social Determinants of Health in Family Medicine Practices
Journal Article
Date: 10/2023
This study evaluated physician, practice, and community characteristics as health care system elements to determine the ability of a primary care practice to address social determinants of health.
Colorectal Cancer Screening in Rural and Urban Primary Care Practices Amid Implementation of the Medicare Access and CHIP Reauthorization Act
Journal Article
Date: 06/2023
This study examined whether colorectal cancer screening rates improved among rural and urban primary care practices amid implementation of the Medicare Access and CHIP Reauthorization Act. Researchers tested for rural/urban differences and changes in screening rates between 2016 and 2020.
Diabetes Prevalence and Monitoring in Nonmetropolitan and Metropolitan Areas Within a Commercially Insured U.S. Population
Policy Brief
Date: 06/2023
This study used recent claims data, from services received between 2018 and 2020, to examine the prevalence of diabetes and to determine if patients with diabetes are more or less likely to receive annual hemoglobin A1c screening.
Psychological Distress Is More Common in Some Occupations and Increases With Job Tenure: A Thirty-Seven Year Panel Study in the United States
Journal Article
Date: 03/2023
This study used 1981–2017 data from the Panel Study of Income Dynamics and the Screening Scale for Psychological Distress (Kessler K6) to identify occupations with low and high risks of mental health problems in the United States.

2022

Medicaid Expansion and Access to Naloxone in Metropolitan and Nonmetropolitan Areas
Journal Article
Date: 11/2022
This study evaluated the association of Medicaid expansion at the state level on the number of naloxone prescriptions dispensed and the percentage paid by Medicaid. Increasing the percentage of Medicaid-paid naloxone prescriptions improved access in metro areas.
Increased Rates of Death From Unintentional Injury Among Non-Hispanic White, American Indian/Alaska Native, and Nonmetropolitan Communities
Policy Brief
Date: 07/2022
This brief examines the rate of fatal and nonfatal unintentional injuries in nonmetropolitan and metropolitan areas, with a focus on the effects of race/ethnicity.
Non-Metropolitan and Metropolitan Trends in Mental Health Treatment Availability in Community Health and Community Mental Health Centers
Policy Brief
Date: 06/2022
This study shows how the supply of community mental health centers (CMHCs) and community health centers (CHCs) delivering mental health services changed from 2000 to 2019. While the supply of CHCs offering mental health services increased, the supply of CMHCs decreased.
The Racial and Ethnic Diversity of the Family Physician Workforce in Non-Metropolitan and Metropolitan Counties
Policy Brief
Date: 06/2022
Racial/ethnic concordance of clinicians and patients may improve health outcomes by increasing access to care for underserved populations. Our objective was to determine the distribution of family physicians (FPs) in rural areas by race/ethnicity and also whether rural minority FPs were more likely to be in underserved rural areas.
Estimating Mortality From Coal Workers' Pneumoconiosis Among Medicare Beneficiaries With Pneumoconiosis Using Binary Regressions for Spatially Sparse Data
Journal Article
Date: 02/2022
This study estimates mortality from coal workers' pneumoconiosis and other pneumoconioses among Medicare beneficiaries using the 5% Medicare Limited Claims Data Set, 2011-2014.
Serious Mental Illness and Mental Health Treatment Utilization Among Adults Residing in Non-Metropolitan and Metropolitan Counties
Policy Brief
Date: 02/2022
This report estimates and compares the prevalence of mental health treatment utilization and reasons for not seeking mental health treatment among adults with serious mental illness residing in non-metropolitan and metropolitan counties nationally.

2021

Suicide Mortality Rates in Farm-Related Occupations and the Agriculture Industry in the United States
Journal Article
Date: 09/2021
This article examines suicide mortality among agricultural workers comparing rural and urban residents using pooled data from the Mortality‐Linked National Health Interview Survey, 1986–2014.
Medicare-Paid Naloxone: Trends in Nonmetropolitan and Metropolitan Areas
Policy Brief
Date: 05/2021
Naloxone is an opioid overdose reversal medication. Medicare beneficiaries benefit from access to naloxone because they have high rates of high-dose prescription opioids. This brief examines trends in Medicare-paid naloxone dispensing rates in nonmetropolitan versus metropolitan areas from 2014 to 2018.
Spatial Analysis of Healthcare Utilization Among Medicare Beneficiaries With Coal Workers' Pneumoconiosis and Other Related Pneumoconiosis
Policy Brief
Date: 04/2021
Miners risk developing coal workers' pneumoconiosis (black lung disease) and other pneumoconiosis. This study determines, maps, and analyzes the spatial patterns of healthcare utilization among Medicare beneficiaries with black lung disease and other related pneumoconiosis using the Medicare beneficiaries Limited Data Set from 2011-2014.

2020

The Declining Scope of Practice of Family Physicians Is Limited to Urban Areas
Journal Article
Date: 11/2020
The scope of practice for family medicine physicians has decreased in recent years. Using survey data, researchers compared family medicine physicians' scope of practice scores based on rural-urban status and other variables. Researchers found statistically significant decreases in scope of practice scores in urban settings.
Risky Substance Use Behaviors Among Adolescents Residing in Nonmetropolitan and Metropolitan Counties in the United States, 2017-2018
Policy Brief
Date: 11/2020
This brief uses nationally representative survey data to compare past-30 day and past-year risky substance use among adolescents 12 to 17 years of age residing in metropolitan and nonmetropolitan counties. Specifically, we compared consumption of alcohol, tobacco, and other illicit substances.
Risky Substance Use Behaviors Among Adults Residing in Nonmetropolitan and Metropolitan Counties in the United States, 2017-2018
Policy Brief
Date: 11/2020
This brief uses nationally representative survey data to identify differences in past-30 day and past-year risky substance use among adults, including alcohol, tobacco, and illicit drugs. This data indicates some significant differences in substance use consumption.
Mortality Among Workers Employed in the Mining Industry in the United States: A 29‐Year Analysis of the National Health Interview Survey—Linked Mortality File, 1986‐2014
Journal Article
Date: 07/2020
Working in the mining industry increases the risk of chronic diseases and mortality. We investigated overall and cause‐specific mortality rates among workers employed in the mining sector in the U.S.
Major Depression, Treatment Receipt, and Treatment Sources Among Non-Metropolitan and Metropolitan Adults
Policy Brief
Date: 06/2020
This study estimates and compares the prevalence of past year depression, receipt of treatment for depression, and sources of treatment for depression between non-metropolitan and metropolitan adults.
Rural/Urban Disparities in the Utilization of Health and Behavioral Assessments/Interventions in the Fee-for-Service Medicare Population
Policy Brief
Date: 06/2020
Identifying behaviors that contribute to disease and modifying them can be an important step in treatment. This study investigated geographic disparities and the availability of Health and Behavioral Assessments and Interventions services in rural and urban areas by examining fee-for-service Medicare beneficiaries in 2012-2016.
Rural/Urban Disparities in Utilization of Diabetes Self-Management Training to the Fee-for-Service Medicare Population
Policy Brief
Date: 06/2020
Diabetes self-management training (DSMT) is recommended for all newly diagnosed patients with diabetes. However, the utilization rate of DSMT is low, and geographic disparities in availability exist. This study sought to identify the extent of the rural/urban disparity in the provision of DSMT to fee-for-service Medicare beneficiaries in 2012-2016.
Rural/Urban Disparities in Utilization of Medical Nutrition Therapy to the Fee-for-Service Medicare Population
Policy Brief
Date: 06/2020
Medical Nutrition Therapy (MNT) is important in the treatment of many chronic conditions, but the availability of MNT in rural versus urban communities has not been examined. This study sought to identify the availability of MNT in rural and urban communities by examining Medicare fee-for-service beneficiaries in 2012-2016.
Estimating the Prevalence and Spatial Clusters of Coal Workers' Pneumoconiosis Cases Using Medicare Claims Data, 2011‐2014
Journal Article
Date: 03/2020
Workers in the coal mining sector are at increased risk of respiratory diseases, including coal workers' pneumoconiosis (CWP). We investigated the prevalence of CWP and its association with sociodemographic factors among Medicare beneficiaries. We found evidence of significant spatial clustering of CWP in the states and population analyzed.
Early-Career and Graduating Physicians More Likely to Prescribe Buprenorphine
Journal Article
Date: 01/2020
Only a small percentage of people who need treatment for opioid use disorder receive it, including buprenorphine. This paper shows differences in rates of prescribing buprenorphine and intentions to prescribe buprenorphine between early- and mid-to-late career family physicians, based on a survey of physicians taking a certification examination.
Practice Predictors of Buprenorphine Prescribing by Family Physicians
Journal Article
Date: 01/2020
Physicians may prescribe buprenorphine if they obtain a waiver, but relatively few family physicians do so. This paper examines the association between practice characteristics and the likelihood that a family physician will prescribe buprenorphine, based on a survey of physicians seeking board certification in family medicine.

2019

Partial Psychiatric Hospitalization Program Availability in Nonmetropolitan and Metropolitan Hospitals Nationally
Policy Brief
Date: 12/2019
Partial psychiatric hospitalization programs (PPHPs) are intended to reduce or avoid inpatient stays by providing intensive psychiatric services in outpatient settings. We provide national estimates of PPHP availability among nonmetropolitan and metropolitan hospitals and describe the hospital characteristics associated with the provision of PPHPs.
The Prevalence of Chronic Diseases Among Current and Ex-Miners in the United States
Journal Article
Date: 12/2019
This paper compares the prevalence and odds of chronic diseases among ex-miners and current miners, adjusting for certain variables that might influence health outcomes. The analysis found that the prevalence of chronic disease is significantly higher among ex-miners.
Hospital Closures and Short-Run Change in Ambulance Call Times
Journal Article
Date: 11/2019
Hospital closures affect the availability of emergency department services. This paper examines changes in ambulance ride times in areas with hospital closures compared to those in similar areas without hospital closures and separately analyzes changes in ambulance ride times between urban and rural areas and among Medicare-eligible patients.
Declining Endoscopic Care by Family Physicians in Both Rural and Urban Areas
Journal Article
Date: 07/2019
This paper explores the decline in the percentage of family physicians providing endoscopic services overall and in urban and rural areas. This has implications on the availability of colonoscopies, endoscopies, and flexible sigmoidoscopies in areas that lack specialists who perform such services.
Suicidal Thoughts, Plans, and Attempts by Non-Metropolitan and Metropolitan Residence
Policy Brief
Date: 05/2019
Suicide is among the leading causes of death in the US, and rates in non-metropolitan (rural) counties have historically exceeded those in metropolitan (urban) counties. This study examined the prevalence of suicidal thoughts, plans, and attempts by year (2010-2016) and county type (non-metropolitan, small metropolitan, and large metropolitan).
Do Hospital Closures Affect Patient Time in an Ambulance?
Policy Brief
Date: 02/2019
Our study explores how a local hospital closure changes patient time in an ambulance for 9-1-1 calls. Access to emergency department services in communities, especially rural communities, persists as a priority for the Medicare program. We found when hospitals close, rural patients requiring ambulance services are disproportionately affected.

2018

Update: Rural/Urban Disparities in Pneumococcal Vaccine Service Delivery Among the Fee-for-Service Medicare Population, 2012-2015
Policy Brief
Date: 11/2018
Delivery of pneumococcal vaccines to fee-for-service Medicare beneficiaries increased 380% from 2014-2015 as a result of uptake of pneumococcal conjugate vaccine (PCV13). However, a significant rural-urban disparity remains. Pharmacy providers delivered a significantly greater proportion of vaccines in rural versus urban counties.
Rural Family Physicians Have a Broader Scope of Practice Than Urban Family Physicians
Policy Brief
Date: 02/2018
While the scope of practice of family physicians has been shrinking, they still practice broadly, often due to fewer health care resources in rural areas. Using data from family physicians seeking continued board certification in 2014 and 2015, we found that a high percentage of rural family physicians provide nearly every clinical service queried.
Rural Family Physicians in Patient Centered Medical Homes Have a Broader Scope of Practice
Policy Brief
Date: 02/2018
The Patient Centered Medical Home (PCMH) is supposed to provide accessible and comprehensive care. Using data from family physicians seeking to continue their American Board of Family Medicine certification in 2014 and 2015, we found that rural family physicians in PCMH practices generally provide more services than those in non-PCMH practices.
Rural/Urban Disparities in Pneumococcal Vaccine Service Delivery Among the Fee-for-Service Medicare Population
Policy Brief
Date: 02/2018
Using 2014 Medicare data, we found a significant disparity in pneumococcal vaccine service delivery to fee-for-service Medicare beneficiaries. Although primary care providers delivered the majority of pneumococcal vaccines to this population, pharmacy providers delivered a significantly greater proportion of vaccines in rural versus urban counties.
Illicit Drug and Opioid Use Disorders Among Non-Metropolitan Residents
Policy Brief
Date: 01/2018
We provide estimates of the prevalence of illicit drug and opioid use disorders among non-metropolitan adults ages 18-64. Prevalence rates did not decline from 2011-2013 to 2014-2015 despite the implementation of major substance use treatment policies. Of particular concern, heroin use disorder prevalence increased in recent years.
Perceived Treatment Need and Utilization for Illicit Drug and Opioid Use Disorders in Non-Metropolitan Areas
Policy Brief
Date: 01/2018
The vast majority of non-metropolitan adults 18-64 who satisfy criteria for an illicit drug use or opioid use disorder do not perceive a need for treatment or receive formal substance use treatment. Despite policies to increase treatment access during the 2008-2015 study period, we found few changes in perceived treatment need and utilization.

2017

Ambulance Services for Medicare Beneficiaries: State Differences in Usage, 2012-2014
Policy Brief
Date: 10/2017
Ambulance services are at risk of scaling back or dissolving in some places. We analyzed Medicare beneficiaries' use of ambulance services across the U.S. Improved understanding of how beneficiaries, most of whom are elderly, use these services provides vital information for policymakers who set rules and regulations about access to the services.