Rural/Urban Differences in Chronic Diseases and Delay of Needed Care

Adult-onset chronic diseases including cardiovascular disease, congestive heart failure and cancers are leading causes of morbidity and mortality in the U.S. More than 17% of U.S. residents live in rural regions, including a disproportionate number of elderly, veteran or disabled adults. These populations have higher documented rates of morbidity and mortality associated with certain conditions, and are more likely to have uncontrolled or poorly managed chronic disease states. This project examined rural versus urban differences in the prevalence, incidence, stage and severity of selected chronic diseases including heart disease, stroke and these cancers: colon, breast, cervical, prostate, lung and skin. There was a focus on examining foregone or delayed access to preventive or needed care, and whether rural residents present later and with more advanced disease states. We utilized data from the Centers for Disease Control & Prevention Wonder, Health Care Utilization Project and Behavioral Risk Factor Surveillance System, utilizing ICD-9 and ICD10 codes and disease severity indices. For cancer estimates, we also used the Surveillance, Epidemiology and End Results cancer data to derive "stage at diagnosis of cancer" as a measure of delayed screening or foregone medical care.

Publications

• Congestive Heart Failure-Related Hospital Deaths Across the Urban-Rural Continuum in the United States
  Journal Article
  Southwest Rural Health Research Center
  Date: 12/2019
  This study examines congestive heart failure (CHF)-related, in-hospital mortality across six levels of rurality and four census regions. Results indicated CHF-related hospital admissions in small metropolitan, micropolitan, and noncore areas, compared to large central metropolitan areas, were more likely to result in death.