Rural‐urban differences in health care unaffordability
Bibliographic Data
| ID | 19432829 |
|---|---|
| Authors | Hannah MacDougall (0000-0001-7124-3913, University of Minnesota School of Social Work Falcon Heights Minnesota USA, corresponding author), Daniel Mork (0000-0002-7924-0706, Harvard T.H. Chan School of Public Health Boston Massachusetts USA), Stephanie Hanson (0000-0003-2452-1540, University of Minnesota School of Social Work Falcon Heights Minnesota USA), Carrie Henning‐smith (0000-0002-0273-0387, University of Minnesota School of Public Health Minneapolis Minnesota USA) |
| Year | 2024 |
| Volume | 40 |
| Issue | 2 |
| Pages | 376-385 |
| Publication date | 2024-03-01 |
| Peer Reviewed | Yes |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | The Journal of Rural Health (JOURNAL) |
| Journal identifiers | ISSN: 0890-765X • E-ISSN: 1748-0361 |
| Publisher | Wiley (PUBLISHER • GB) |
| DOI | 10.1111/jrh.12788 |
| PMID | 37495555 |
| OpenAlex | W4385294465 |
| Language | EN |
| Citations received | 3 |
| References cited | 12 |
PURPOSE: To compare health care unaffordability in rural versus urban contexts while also examining the impact of sociodemographic/socioeconomic variables on this relationship. METHODS: We examined survey responses from the 2019-2021 National Health Interview Survey (n = 90,761). We conducted chi-squared tests comparing urban and rural subsamples and multivariable logistic regression analyses examining the associations between rurality and 3 measures of health care unaffordability while also including interactions between rurality and individual characteristics of respondents. FINDINGS: In bivariate analyses, compared to their urban counterparts, rural residents were more likely to report problems paying medical bills (15.0% vs 11.5%, P <.001) and being unable to pay medical bills (9.3% vs 7.1%, P < .001). In fully adjusted multivariable regression analyses, rural residents were significantly less likely than their urban counterparts to report being worried about paying medical bills (AOR: .915, CI: .871-.961, P < .001). We found significant interactions between rural residency and insurance type, age, income to poverty ratio, and race/ethnicity for the outcome of problems paying medical bills; and significant interactions between rural residency and income to poverty ratio and race and ethnicity for the outcome of being unable to pay medical bills. CONCLUSION: Rural residents report higher rates of 2 measures of health care unaffordability as compared to their urban counterparts. In multivariable logistic models, rural residency is not associated with higher rates of health care unaffordability; however, significant interactions exist between rural residency and individual variables demonstrating the heterogenous experiences of health care unaffordability based on these intersectional identities
Bivariate analysis · Environmental health · Ethnic group · Health care · Health equity · Logistic regression · Population · Poverty · Public health · Rural area · Rurality · Socioeconomic status · Demography · Global Health Workforce Issues · Healthcare Policy and Management · Medicine · Nursing · Primary Care and Health Outcomes
| Unique citing works | 3 |
|---|---|
| Citations per year | 3 |
| Citation span | 2025 - 2026 (2) |
| Citation velocity | current |
| Highly cited | No |
| Citation types | Neutral: 2 |