The majority of research on rural health disparities focuses on rural-urban differences in health. By focusing only on rural-urban differences, the variability in health among rural residents is unseen. Rural racial and ethnic diversity has increased in recent decades, with a growth in immigrant populations in rural areas. Currently, 1 in 5 rural residents is a person of color or American Indian, adding up to nearly 10 million rural residents who are black, Latinx, Indigenous, Asian, or mixed-race.

Recent work by the Centers for Disease Control and Prevention (James et al.) was a crucial first step toward a more nuanced understanding of racial/ethnic disparities within rural populations. However, there are several important next steps that are necessary to inform targeted policies to improve the health of rural communities and populations. This project will build on the James et al. paper by examining within-rural racial and ethnic differences in preventive care use over time, adding socio-demographic controls, looking at the experience of residents of micropolitan rural counties, and also addressing potential state and regional variation in disparities among rural people. Preventive care use is a fundamental measure of healthcare quality and is essential for population health; disparities in access to and use of preventive services by race and ethnicity will signal where to focus policy and practice efforts to improve the health of rural populations.

This project is national in scope and will have relevance for policy making and healthcare delivery at the federal, regional, state, and local levels. The sample will include adults from rural communities across the U.S. and will be weighted to generate nationally-representative estimates. We plan to analyze racial and ethnic disparities among rural adults in preventive care use from 2007-2016, including having an annual flu shot, a usual provider, annual dental visit, and use of routine cancer screenings, as well as unmet need for physical, mental, dental, and vision care; examine whether disparities in preventive care persist after adjusting for socio-demographic characteristics; identify state and regional differences in within-rural racial and ethnic disparities in preventive care; and compare micropolitan and non-core rural residents to examine whether any racial and ethnic disparities in non-core rural residents are similar in micropolitan counties.

Publications

• Differences in Preventive Care Among Rural Residents by Race and Ethnicity
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 11/2019
  Disparities in preventive care by rural and urban location and by race and ethnicity are well documented in the literature, but less is known about whether there are differences in healthcare use among rural residents by race and ethnicity. We address this gap by examining differences in preventive care among rural residents by race and ethnicity.
• Dying Too Soon: County-Level Disparities in Premature Death by Rurality, Race, and Ethnicity
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 03/2019
  In this brief, we examined county-level differences in premature death (years of potential life lost before age 75 per 100,000 people) by county-level racial and ethnic composition, across rural and urban counties. We also calculated whether there were rural-urban disparities in mortality within counties with similar racial and ethnic compositions.
• Racial and Ethnic Differences in Self-Rated Health Among Rural Residents
  Journal Article
  University of Minnesota Rural Health Research Center
  Date: 09/2020
  This study looks at racial and ethnic differences in self-rated health among rural residents as well as whether these differences can be explained by socio-demographic characteristics. Researchers used data from the 2011–2017 National Health Interview Survey to study differences in rural residents' self-rated health by race and ethnicity.
• Rural Counties With Majority Black or Indigenous Populations Suffer the Highest Rates of Premature Death in the U.S.
  Journal Article
  University of Minnesota Rural Health Research Center
  Date: 12/2019
  Despite well-documented health disparities by rurality and race/ethnicity, research investigating racial/ethnic health differences among U.S. rural residents is limited. We used county-level data to measure and compare premature death rates in rural counties by each county's majority racial/ethnic group.