2023 Research Publications

Browse the full list of research publications from the Rural Health Research Centers.

Products – Freely accessible products include policy briefs, fact sheets, full reports, chartbooks, and interactive data websites.

Journal Articles – Articles in peer-reviewed journals may require a subscription or affiliation with a subscribing library. For these publications, Gateway lists the article citation, a brief summary, a link to additional information and access to the full-text of the article, if available.

Excess Deaths Associated With COVID-19 by Rurality and Demographic Factors in the United States
Journal Article
Maine Rural Health Research Center
Date: 12/2023
Researchers analyzed U.S. mortality data to quantify excess deaths during the COVID-19 pandemic to describe rural-urban disparities by age, sex, and race/ethnicity. There were nearly 17% more deaths than expected between March 2020 and February 2023.
Geographic Variations in Driving Time to U.S. Mental Health Care, Digital Access to Technology, & Household Crowdedness
Journal Article
Rural and Minority Health Research Center
Date: 12/2023
This study compared travel time to mental health facilities in rural versus urban areas and potential barriers to digital devices for telemedicine access in those same rural/urban locations. In addition, the research examined private space within the home as it relates to household crowdedness.
State Priorities and Needs: The Role of Block Grants
Journal Article
Rural Health Equity Research Center
Date: 11/2023
This study looks at state-level funding allocations for 5 federal block grant programs from 2015-2019, and associations with state-level measures of need that align with the purposes of each block grant program.
Medicare Advantage Enrollment Update 2023
Policy Brief
RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
Date: 11/2023
This policy brief continues RUPRI Center's annual update of Medicare Advantage (MA) enrollment including the changes in enrollment in types of MA plans, and health policy changes that may have had an impact.
Rural/Urban Differences in Receipt of Governmental Rental Assistance: Relationship to Health and Disability
Journal Article
University of Minnesota Rural Health Research Center
Date: 10/2023
Housing is a vital component of health, and governmental rental assistance is one avenue of increasing access to affordability. In this paper, researchers examined rural/urban and within-rural differences in receipt of governmental rental assistance, with a focus on differences by health and disability.
Addressing Social Determinants of Health in Family Medicine Practices
Journal Article
Rural and Underserved Health Research Center
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.
Key Informant Perspectives on Rural Housing and Health
Policy Brief
University of Minnesota Rural Health Research Center
Date: 10/2023
In this policy brief, using content analysis of interview data, researchers share rural-specific housing barriers, including those that are related to health, as well as policy recommendations for addressing housing challenges to improve rural health.
Travel for Medical or Dental Care by Race/Ethnicity and Rurality in the U.S.: Findings From the 2001, 2009 and 2017 National Household Travel Surveys
Journal Article
Southwest Rural Health Research Center
Date: 10/2023
This study examines trends in the travel distance and time for medical/dental care trips. Using 2001 to 2017 data from the National Household Travel Survey, our analysis found that travel distance and time increased for rural residents relative to urban residents.
Rural Emergency Hospital Map and Data
North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
Date: 10/2023
This interactive map tracks hospitals that have converted to Rural Emergency Hospitals since January 2023.
Unmet Needs for Help With Mobility Limitations Among Older Adults Aging in Place: The Role of Rurality
Journal Article
University of Minnesota Rural Health Research Center
Date: 10/2023
This study identifies differences in unmet mobility needs among older adults by rurality. It uses data from the National Health and Aging Trends Study, limiting analyses to respondents who had not moved since baseline (average housing tenure of 27 years; n = 3343).
Suitability of Low-Volume Rural Emergency Departments to New Rural Emergency Hospital Designation
Journal Article
North Carolina Rural Health Research and Policy Analysis Center, Rapid Response to Requests for Rural Data Analysis
Date: 09/2023
The Rural Emergency Hospital is a new Medicare payment model that requires hospitals to focus on emergency, observation, and outpatient services in lieu of inpatient care. This study's exploratory objective was to examine care delivery from eligible hospitals to assess their fit with the new payment model.
Characteristics of Short-Term Acute Care Hospitals That Experienced a Ransomware Attack From 2016 to 2021
Journal Article
University of Minnesota Rural Health Research Center
Date: 08/2023
Ransomware is a type of malicious software designed to block access to a computer system until a sum of money is paid. In this paper, researchers compare the characteristics (including rurality) of ransomware-attacked and non-attacked hospitals in the U.S. in order to understand which hospitals may be most vulnerable to cybercrime.
Multi-Sector Collaboration to Support Rural Aging
Journal Article
University of Minnesota Rural Health Research Center
Date: 08/2023
In this paper, researchers examine the lessons rural areas present for supporting aging, including the role that aging and social services, public health systems, and health care have to play.
Access to Health Care for Transgender and Gender-Diverse Adults in Urban and Rural Areas in the United States
Journal Article
University of Minnesota Rural Health Research Center
Date: 08/2023
This study examines access to care based on gender identity in urban and rural areas, focusing on transgender and gender diverse (TGD) populations. Data came from the 2019 to 2020 Behavioral Risk Factor Surveillance System. Researchers found greater barriers to care for TGD adults, with the most frequent barriers found among rural TGD adults.
Rural/Urban Differences in Rates and Predictors of Intimate Partner Violence and Abuse Screening Among Pregnant and Postpartum United States Residents
Journal Article
University of Minnesota Rural Health Research Center
Date: 08/2023
This paper uses the 2016-2020 Pregnancy Risk Assessment Monitoring System (PRAMS) data to describe rates and predictors of perinatal intimate partner violence (IPV) and rates and predictors of not being screened for abuse among rural and urban IPV victims who gave birth.
Examining Rural-Urban Differences in the Availability of Hospital-Based Cardiac Services Between 2010-2020
Policy Brief
Rural and Minority Health Research Center
Date: 08/2023
This study examines the availability of hospital-based cardiac health care services (general cardiology, diagnostic catheterization, and interventional catheterization) and whether rural-urban differences in the availability of these health care services occurred between 2010 and 2020.
Assessing Key Indicators of Rural Versus Urban Water Quality
Policy Brief
Rural and Minority Health Research Center
Date: 08/2023
This study presents a summary of water quality monitoring data sources and models, identifies the gaps that persist, and proposes the salient categories and types of data that should be contained in a national water quality monitoring database to accurately describe rural water quality.
Availability of Dialysis Facilities in Minoritized Racial/Ethnic Group Areas
Policy Brief
Rural and Minority Health Research Center
Date: 08/2023
This brief is one of a series of findings briefs documenting disparities in geographic access to health services for ZIP code tabulation areas containing a high proportion of minoritized racial/ethnic residents. The brief looks at the availability of dialysis providers in minoritized racial/ethnic areas.
Availability of Primary Care Safety Net Providers in Minoritized Racial/Ethnic Group Areas
Policy Brief
Rural and Minority Health Research Center
Date: 08/2023
This brief is one of a series of findings briefs documenting disparities in geographic access to health services for ZIP code tabulation areas containing a high proportion of minoritized racial/ethnic residents. This report looks at the distance to the nearest primary care safety net provider.
A Consensus Panel Approach to Estimating the Start-Up and Annual Service Costs for Rural Ambulance Agencies
Policy Brief
Maine Rural Health Research Center
Date: 08/2023
This brief fills the information void on the costs of running rural ambulance services and establishes a minimum access standard for ambulances servicing a 25-minute travel time radius from the ambulance station, enabling policymakers and community stakeholders to develop strategic plans for the financing and provision of ambulance services.
Distributional Analysis of Variation in Medicare Advantage Participation Within and Between Metropolitan, Micropolitan, and Noncore Counties
Policy Brief
RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
Date: 08/2023
This brief identifies patterns and trends in Medicare Advantage participation (penetration rates, number of plans, and enrollment), both within and across metropolitan and nonmetropolitan counties.
Eight Postpartum Support Programs in Rural Communities Across the United States
University of Minnesota Rural Health Research Center
Date: 08/2023
This case study series highlights locally focused organizations working to improve postpartum health for rural residents across the United States. Interviews were conducted with eight unique organizations working in their local rural communities to support postpartum health.
The Relationship Between Experience With Mental Illness and Stigmatizing Attitudes and Beliefs
Policy Brief
Rural Health Equity Research Center
Date: 08/2023
This policy brief documents the relationship between self-reported experience with any mental illness (whether first-hand or second-hand) and public stigma associated with mental illness. Differences in the prevalence of experience with mental illness by geography are also explored.
Differences in Residential Stability by Rural/Urban Location and Socio-Demographic Characteristics
Policy Brief
University of Minnesota Rural Health Research Center
Date: 08/2023
This policy brief identifies rural/urban differences in residential stability and examines rural/urban differences in regional, socio-demographic, and health characteristics associated with living in the same home for more than 20 years.
Housing Quality by Disability, Race, Ethnicity, and Rural-Urban Location: Findings From the American Community Survey
Policy Brief
University of Minnesota Rural Health Research Center
Date: 07/2023
In this policy brief, researchers examine rates of two key housing quality indicators (having incomplete plumbing and incomplete kitchen facilities) by rural-urban location, as well as at the intersections of racial/ethnic identity and disability status.
State Differences in Recommended Components of Care Received During Postpartum Visits for Rural and Urban Residents, 2016-2019
Policy Brief
University of Minnesota Rural Health Research Center
Date: 07/2023
The purpose of this policy brief is to measure state-level differences in the receipt of recommended postpartum care components among rural and urban residents in the United States who gave birth from 2016 to 2019.
Two National-Level Organizations Supporting Rural Postpartum Health Across the United States
University of Minnesota Rural Health Research Center
Date: 07/2023
The purpose of this case study series is to highlight national-level organizations working in innovative ways to improve postpartum health for rural residents across the United States. These may serve as examples to others considering this work.
Accommodation and Acceptability of Health Care by Non-Metropolitan/Metropolitan and Race/Ethnicity Status
Policy Brief
Rural and Minority Health Research Center
Date: 07/2023
This research examined rural-urban (i.e., non-metropolitan/metropolitan) differences in accommodation and acceptability of health care by operationalizing two survey questions from the health care access optional module of the Behavioral Risk Factor Surveillance System survey.
Opportunities and Challenges of Using Carve-Outs to Fund Rural Public Health Initiatives: Evidence From the COVID-19 Pandemic
Journal Article
Southwest Rural Health Research Center
Date: 06/2023
This project explores the impact and lessons learned from the first large-scale rural carve out of a CDC funding initiative. Based on stakeholder interviews, our analysis found they supported this funding mechanism and that the funds were being used in interesting and creative ways.
Spatial Clustering of COVID-19 Mortality Rates Across Counties and by Noncore, Micropolitan, and Metropolitan County Characteristics, December 2020–January 2021
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 06/2023
This policy brief identifies spatial clusters of high COVID-19 mortality rates across counties in the United States between December 2020 and January 2021 and describes the characteristics of counties with high COVID-19 mortality rates.
Differences in the Merit-Based Incentive Payment System (MIPS) Performance of Clinicians in Metropolitan and Nonmetropolitan Counties in 2018
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 06/2023
This brief describes rural clinician performance in the Merit-based Incentive Payment System in 2018, testing the supposition that they did not do as well as their urban counterparts.
Colorectal Cancer Screening in Rural and Urban Primary Care Practices Amid Implementation of the Medicare Access and CHIP Reauthorization Act
Journal Article
Rural and Underserved Health Research Center
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.
Maniilaq Health Center: Providing High-Quality Obstetric Care to American Indian/Alaska Native People in Rural Kotzebue, Alaska
University of Minnesota Rural Health Research Center
Date: 06/2023
This case study highlights a hospital providing care to rural American Indian and Alaska Native patients within the state of Alaska. The study examines the maternity care context with attention to the intersection of race and geography with social determinants of health.
Diabetes Prevalence and Monitoring in Nonmetropolitan and Metropolitan Areas Within a Commercially Insured U.S. Population
Policy Brief
Rural and Underserved Health Research Center
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.
Understanding and Overcoming Barriers to Rural Training in Family Medicine Obstetrics Fellowships
Policy Brief
WWAMI Rural Health Research Center
Date: 06/2023
This policy brief describes the results of a survey on the characteristics and challenges faced by rurally oriented family medicine obstetrics fellowship programs. All survey respondents reported their programs had a mission to train family physicians for rural practice, yet less than one-third of programs reported they required rural training.
Factors Associated With Hospitalizations for Co-occurring HIV and Opioid-related Diagnoses: Evidence From the National Inpatient Sample, 2009-2017
Journal Article
Southwest Rural Health Research Center
Date: 05/2023
This study explores trends in co-occurring HIV and opioid-related hospitalizations and identifies key risk factors.
Policy Implications of Fixed-to-Total-Cost Ratio Variation Across Rural and Urban Hospitals
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 05/2023
This article utilizes hospital cost report data to estimate the relationship between adjusted volume and total costs of patient care. These results are used to estimate fixed-to-total-cost ratios for all nonfederal, short-term acute care hospitals in the U.S. These ratios were then stratified by rurality and Critical Access Hospital status.
Ambulance Deserts: Geographic Disparities in the Provision of Ambulance Services
Chartbook
Maine Rural Health Research Center
Date: 05/2023
Access to timely ambulance service is an essential part of the emergency medical system. Yet ambulance access varies widely with significant gaps across the country. This research identifies places and people that are more than 25 minutes from an ambulance station, also called an ambulance desert.
Rural Healthy People 2030: Common Challenges, Rural Nuances
Policy Brief
Southwest Rural Health Research Center
Date: 05/2023
This study analyzes the most important Healthy People 2030 priorities for rural America. Data collected from a survey found mental health, substance use, health care access, and economic stability were among the most important priorities. This information could be used to accelerate health improvements in rural America.
Distribution of Direct Care Workforce COVID-19 Funding Between Rural and Urban Counties in Minnesota and Illinois
Policy Brief
University of Minnesota Rural Health Research Center
Date: 05/2023
The purpose of this policy brief is to examine trends in the distribution of federal Coronavirus Aid, Relief, and Economic Securities Act of 2020 (CARES Act) funding designed to support the direct care workforce between rural and urban counties in Minnesota and Illinois.
Factors Associated With Lengths-of-Stay for Inpatients With Substance Use Disorders
Policy Brief
Rural Health Equity Research Center
Date: 04/2023
This policy brief identifies factors associated with inpatient length-of-stay (LOS) for the treatment of substance use disorders (SUDs), and whether there are systematic differences in LOS for rural and urban residents.
Rural and Urban Differences in Factors Associated With Inpatient Hospital Stays for Substance Use Disorder
Policy Brief
Rural Health Equity Research Center
Date: 04/2023
Using 2018 all-payer claims data from seven states, this brief describes the lengths and costs of inpatient hospital stays for substance use disorders and examines whether there were differences between stays for rural and urban residents.
Rural and Urban Differences in Insurance Coverage at Prepregnancy, Birth, and Postpartum
Journal Article
University of Minnesota Rural Health Research Center
Date: 03/2023
In this manuscript, the research team used data from the Pregnancy Risk Assessment Monitoring System to measure insurance coverage at prepregnancy, birth, and postpartum, and insurance coverage continuity across these periods among rural and urban U.S. residents.
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
Rural and Underserved Health Research Center
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.
Rural Healthy People 2030: New Decade, New Challenges
Journal Article
Southwest Rural Health Research Center
Date: 03/2023
This study reports the findings of Rural Healthy People 2030, a companion piece to the Healthy People 2030 initiative with a focus on health priorities of rural populations. Data was collected from a survey given to rural stakeholders. Mental health, substance use, health care access, and economic stability were among the most important priorities.
Understanding and Overcoming Barriers to Rural Obstetric Training for Family Physicians
Journal Article
WWAMI Rural Health Research Center
Date: 03/2023
Family physicians are the most common health professional providing rural obstetric (OB) care, but the number of family physicians practicing OB is declining. This mixed-methods study aimed to inform policy and practice solutions to address the training landscape and inform sustainable initiatives for rural family medicine obstetrical training.
Rural Working-Age Adults Report More Cost Barriers to Health Care
Policy Brief
Maine Rural Health Research Center
Date: 03/2023
Using the 2019-2020 National Health Insurance Survey, this study examined rural-urban differences in affordability of care and cost-saving strategies among working-age adults.
COVID-19 Vaccination Rates
Policy Brief
RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
Date: 03/2023
This rural data brief provides a longitudinal examination of completion of primary COVID-19 vaccination series in the age-eligible population in metropolitan, micropolitan, and noncore counties.
Indicators of Familial Social Support by Rurality and Gender Identity
Policy Brief
University of Minnesota Rural Health Research Center
Date: 03/2023
Social and emotional support from family significantly contributes to positive health outcomes. Understanding how familial social support differs for those with overlapping marginalized identities is critical to advance population health and health equity. This brief examines differences in familial social support by rurality and gender identity.
Analysis of an Innovative Approach to Target Rural Communities in Public Health Funding
Policy Brief
Southwest Rural Health Research Center
Date: 03/2023
The CDC launched a new initiative to address COVID-19 related health disparities and to advance health equity among underserved and at-risk populations. Based on stakeholder interviews, this project explores the formation of this initiative, its impact on rural health, and lessons learned that can be applied to future rural-focused funds.
Financial Risk Acceptance Among Rural Health Care Providers Participating in the Quality Payment Program
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 03/2023
This policy brief summarizes non-metropolitan and metropolitan providers' participation in different Centers for Medicare & Medicaid Services Quality Payment Program tracks and subdivisions, and evaluates provider and patient-panel characteristics associated with financial risk acceptance.
Access to Health Services Across Rural and Urban Minoritized Racial/Ethnic Group Areas
Policy Brief
Rural and Minority Health Research Center
Date: 03/2023
This brief summarizes selected results from a series of reports documenting disparities in geographic access to health services for rural and urban places that have a relatively high proportion of residents from minoritized racial and ethnic groups. "Areas" were examined at the ZIP Code Tabulation Area level.
Assessing Geographic Variability in Key Indicators of Air Quality: A Rural vs. Urban Comparison of Pollution and Socio-Economic Factors
Policy Brief
Rural and Minority Health Research Center
Date: 03/2023
The purpose of this study was to examine rates of air pollution between rural and urban census tracts. In addition, urban-rural disparities in exposure to polluted air across Environmental Protection Agency-defined regions were examined.
The COVID-19 Pandemic Impact on Independent and Provider-Based Rural Health Clinics' Operations and Cancer Prevention and Screening Provision in the United States
Journal Article
Rural and Minority Health Research Center
Date: 03/2023
The provision of Rural Health Clinic (RHC) cancer prevention and screening services was examined to identify any changes pre- and peri-pandemic. The research examined overall provision of cancer prevention and screening services by RHCs and the provision of these services by independent RHCs and by provider-based RHCs .
Crowded Housing and Housing Cost Burden by Disability, Race, Ethnicity, and Rural-Urban Location
Policy Brief
University of Minnesota Rural Health Research Center
Date: 03/2023
Housing is closely tied to health outcomes and well-being; however, little research examines housing factors by location. In this policy brief, we examine rates of crowded housing and housing cost burden by rural-urban location, as well as at the intersections of race, ethnicity, and disability status.
Rural-Urban Differences in Workers' Access to Paid Sick Leave
Journal Article
Maine Rural Health Research Center
Date: 02/2023
The authors analyzed the prevalence of paid sick leave (PSL) among rural versus urban workers and found that rural workers had lower access to PSL than urban workers, even after adjusting for worker and employment characteristics, especially those who were Hispanic, lacked employer-sponsored insurance, and reported poorer health status.
Advancing the Age-Friendly Movement in Rural Communities
Journal Article
University of Minnesota Rural Health Research Center
Date: 02/2023
The research team looked at the role of Aging Life Care Managers® to help support the age-friendly movement in rural areas. The team explored ways in which Aging Life Care Managers® could advocate for the needs and interests of their clients, help them access care and support, and involve rural communities in the age-friendly movement.
Who Will Care for Rural Older Adults? Measuring the Direct Care Workforce in Rural Areas (journal article)
Journal Article
University of Minnesota Rural Health Research Center
Date: 02/2023
In this manuscript, the research team used data from the 2021 Occupational Employment and Wage Statistics dataset to calculate the ratio of direct care workers relative to the population of older adults (ages 65+) across rural and urban areas in the US.
Rural School- and Community-Based Programs Supporting LGBTQ+ Youth
University of Minnesota Rural Health Research Center
Date: 02/2023
The purpose of this case series is to highlight youth-focused and school- and community-based organizations that affirm and support LGBTQ+ individuals in their rural communities. These may serve as examples to others considering this work.
Rural Population Health in the United States: A Chartbook
Chartbook
North Carolina Rural Health Research and Policy Analysis Center
Date: 02/2023
This chartbook uses a range of indicators to describe population health in rural America and document health disparities between rural and urban areas. This report includes 33 measures of population health, organized into five domains: Access to Care, Health Outcomes and Risks, Mortality, Social Determinants of Health, and Socioeconomics.
Community Sociodemographics and Rural Hospital Survival Analysis
Policy Brief
Center for Economic Analysis of Rural Health
Date: 01/2023
This study examines which community sociodemographic characteristics are associated with increased risk of rural hospital closure between 2010-2019. Results show that rural hospitals at risk of financial distress are more likely to experience closure if their communities have higher unemployment and higher uninsurance for those under 65.
Medicare Advantage Enrollment Update 2022
Policy Brief
RUPRI Center for Rural Health Policy Analysis, Rapid Response to Requests for Rural Data Analysis
Date: 01/2023
The 2022 report continues the RUPRI Center's annual series of Medicare Advantage (MA) enrollment updates. In addition to tracking overall and nonmetropolitan/metropolitan enrollment, this brief also reports on changes in enrollment in types of MA plans and considers policy changes from previous years that may have impacted MA plan enrollment.
Changes in Service Offerings Post-System Affiliation in Rural Hospitals
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 01/2023
This policy brief aims to understand the range of effects on service offerings after rural hospitals become part of, or leave, a regional or national healthcare system.
COVID-19 Mortality Rates Across Noncore, Micropolitan, and Metropolitan Counties by Community Characteristics, December 2020-January 2021
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 01/2023
This policy brief examines differences in COVID-19 mortality rates across rural-urban designations and stratifications by geography, county-level sociodemographic factors, and county-level healthcare factors.
Variations in Affordability of Health Care by Non-Metropolitan/Metropolitan and Race/Ethnicity Status Across Eight Geographically Dispersed States
Policy Brief
Rural and Minority Health Research Center
Date: 01/2023
This research examined rural-urban (i.e., non-metropolitan/metropolitan) differences in affordability inclusive of insurance coverage and cost barriers. The research also examined forgoing medical care/medication and medical debt using Behavioral Risk Factor Surveillance System survey data from the healthcare access optional module.