Rural Health
Research Gateway

Health disparities and health equity

Current Projects

  • Access to and Provision of Child and Youth Behavioral Health Services in the Rural and Urban U.S.
    The need for behavioral health treatment for youth has been exacerbated by the COVID-19 pandemic. Little is known about the availability of youth behavioral health providers in rural areas. This study will investigate who provides behavioral health services to youth, how equitably the workforce is distributed, and gaps in service availability.
    Research center: WWAMI Rural Health Research Center
    Topics: Allied health professionals, Children and adolescents, Health disparities and health equity, Health services, Healthcare access, Mental and behavioral health, Nurses and nurse practitioners, Pharmacy and prescription drugs, Physician assistants, Physicians, Substance use and treatment, Workforce
  • Addressing Elder Abuse in Rural Areas
    Elder abuse, including financial, physical, and emotional abuse, as well as self-neglect, is widespread and impacts individual and population health outcomes. However, despite the fact that rural residents are older, in poorer health, and more financially vulnerable, little is known about rural/urban differences in the prevalence of and resources to address elder abuse; this project will address those gaps.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Aging, Disabilities, Health disparities and health equity, Social determinants of health, Violence and abuse
  • Assessment of the Area Deprivation Index in Rural Areas
    The Area Deprivation Index (ADI) was created by University of Wisconsin researchers to provide a score for neighborhoods based on their level of disadvantage. This study will characterize differences in ADI in rural vs urban areas, summarize the existing literature on ADI, and describe expert considerations for utilizing the ADI for future policy.
    Research center: Rural Health Equity Research Center
    Topics: Frontier health, Health disparities and health equity, Poverty, Rural statistics and demographics, Social determinants of health
  • Availability, Care Practices, and Quality of Hospice Providers Serving Rural versus Urban Communities
    This project will examine differences in availability of hospice care in rural versus urban communities as well as provider-level quality and care practices by rural-urban status of hospices. Findings will highlight potential rural-urban disparities in hospice care that can be used to inform future Medicare policy.
    Research center: WWAMI Rural Health Research Center
    Topics: Aging, Coronavirus Disease 2019 (COVID-19), Health disparities and health equity, Health services, Healthcare access, Hospice and palliative care, Medicare, Quality
  • Building the Rural Evidence Base: Examining the Feasibility of Implementing Pilot Programs and Demonstrations in Rural Communities
    Evidence-based interventions are commonly developed in populated, urban centers and then adapted for rural communities. This project will investigate the benefits of piloting and evaluating interventions in rural areas to build the rural evidence base as a step in addressing health disparities and improving health conditions in rural communities.
    Research center: Rural Health Equity Research Center
    Topics: Health disparities and health equity, Health promotion and disease prevention, Health services
  • Challenges, Successes, and Sustainability of the 2019 Rural Maternity and Obstetrics Management Strategies (RMOMS) Programs
    This mixed-methods study aims to understand awardees' experiences in building and maintaining cohesive networks for Rural Maternity and Obstetrics Management Strategies (RMOMS).
    Research center: Rural and Minority Health Research Center
    Topics: Health disparities and health equity, Health services, Healthcare access, Maternal health, Minority health, Networking and collaboration, Telehealth, Women
  • Changes in Access to Care During the Public Health Emergency: Examining Rural-Urban Disparities by Insurance Type
    Using the Behavioral Risk Factor Surveillance System data, this study will compare key access to care indicators among adult beneficiaries residing in rural and urban areas before and after the Public Health Emergency by types of health insurance. Researchers will explore state-level policy variations, such as the Affordable Care Act Medicaid expansion and COVID-19-related Medicaid coverage for uninsured adults.
    Research center: Rural and Underserved Health Research Center
    Topics: Health disparities and health equity, Healthcare access, Healthcare financing, Medicaid and CHIP, Uninsured and underinsured
  • Changes in Buprenorphine Prescribing Following the Elimination of the Drug Enforcement Administration X Waiver Requirement
    The Drug Enforcement Administration requirement for an X waiver to prescribe buprenorphine for opioid use disorder was lifted in January 2023. This study aims to describe if and how this policy change has impacted the prescribing practices of clinicians and medication treatment access for patients with opioid use disorder.
    Research center: WWAMI Rural Health Research Center
    Topics: Health disparities and health equity, Health services, Healthcare access, Legislation and regulation, Mental and behavioral health, Nurses and nurse practitioners, Physician assistants, Physicians, Substance use and treatment, Workforce
  • Changes in Medicare Fee-for-Services Health Care Expenditures in Rural and Urban Communities after Passage of the Affordable Care Act
    This project will assess changes in Medicare per-beneficiary spending across rural and urban counties from 2007 to 2020. It will examine differences in rural versus urban per-beneficiary spending on hospital inpatient, hospital outpatient, physician, and post-acute care after the Affordable Care Act (ACA).
    Research center: Rural and Minority Health Research Center
    Topics: Care management, Chronic diseases and conditions, Health disparities and health equity, Health services, Hospitals and clinics, Public health
  • Characteristics of Buprenorphine Therapy Among Commercially-Insured Pregnant and Postpartum Women
    This project will analyze claims from a national commercial insurance database to characterize buprenorphine therapy initiation persistence and adherence among pregnant and postpartum women with opioid use disorder (OUD) and assess differences in buprenorphine OUD treatment characteristics among rural and urban pregnant/postpartum women.
    Research center: Rural Health Equity Research Center
    Topics: Health disparities and health equity, Healthcare access, Maternal health, Substance use and treatment
  • Comparing Across Health Indices: Differences by Rurality, Missingness, and Associations With Health Outcomes
    The purpose of this study is to describe and compare existing area-level indices of vulnerability by rurality and to examine associations between indices and health outcomes of interest by area-level measures of rurality.
    Research center: Rural Health Equity Research Center
    Topics: Health disparities and health equity, Healthcare access, Poverty, Rural statistics and demographics, Social determinants of health, Uninsured and underinsured
  • Comparing Utilization and Quality of Home Health Care Between Medicare Fee-for-Service and Medicare Advantage Beneficiaries by Rural-Urban Status
    This project examines differences in home health use and quality by enrollment in Medicare Fee-for-Service (FFS) versus Medicare Advantage (MA) plans. Findings will include information on rural-urban and intra-rural variation in home health care to inform policies on access, payment, and quality for Medicare FFS and MA plans.
    Research center: WWAMI Rural Health Research Center
    Topics: Aging, Allied health professionals, Health disparities and health equity, Health services, Healthcare access, Healthcare financing, Home health, Medicare, Medicare Advantage (MA), Post-acute care, Quality
  • Dentist Supply, Dental Care Utilization, and Oral Health Among Rural and Urban U.S. Residents: Exploring Changes in the Past 15 Years
    This project will describe the national supply of the rural and urban dental workforce and investigate whether rural adults, compared to urban adults, report lower dental care utilization, higher prevalence of dental disease or both. This study will also look at whether disparities in oral health care and supply have changed over the past 15 years.
    Research center: WWAMI Rural Health Research Center
    Topics: Allied health professionals, Health disparities and health equity, Health services, Healthcare access, Oral health, Workforce
  • Disparities in Screening, Prevention, and Management of Cardiovascular Disease in Rural and Urban Primary Care
    This study will use a large national primary care registry to compare cardiovascular disease (CVD) screening, prevention, and management quality measures between rural and urban primary care practices. It will also assess for disparities by patient composition (race/ethnicity, insurance) of the practice.
    Research center: Rural and Underserved Health Research Center
    Topics: Care management, Chronic diseases and conditions, Health disparities and health equity, Health promotion and disease prevention, Health services, Minority health, Physicians, Quality
  • Evaluating the Impact of Inflation Reduction Act Provisions on Medicare Advantage Prescription Drug Costs
    Using Merative MarketScan data, this study will evaluate changes in the affordability of prescription drugs for urban and rural Medicare beneficiaries before and after the recent Inflation Reduction Act (IRA). The primary outcome will be an assessment of whether the IRA succeeded in reducing costs and identifying any remaining health disparities.
    Research center: Rural and Underserved Health Research Center
    Topics: Health disparities and health equity, Healthcare financing, Medicare Advantage (MA), Pharmacy and prescription drugs
  • Examining Changes in Health Care Accessibility in Rural Areas: An Analysis of HPSAs and MUAs Over Time and Their Relationship With Demographic Characteristics
    This study focuses on Health Professional Shortage Areas and Medically Underserved Areas and analyzes health care accessibility in rural areas. It uses data from the Health Resources and Services Administration and demographic information to identify trends, spatial patterns, and demographic intersections, aiming to inform policies and interventions for improved rural healthcare access and equity.
    Research center: Rural Health Equity Research Center
    Topics: Health disparities and health equity, Healthcare access, Mental and behavioral health, Oral health, Workforce
  • Examining Differences in Rural and Urban Medicare FFS Beneficiaries' Emergency Department Use Pre-COVID-19 and During COVID-19
    This study describes and compares the differences in the utilization of emergency department (ED) services among rural and urban Medicare Fee-For-Service enrollees during 2018-2021. We will identify factors associated with differences in ED use, including shifts in volume, primary diagnoses, and admission source, before and since the COVID-19 public health emergency in rural and urban areas.
    Research center: Rural Health Equity Research Center
    Topics: Coronavirus Disease 2019 (COVID-19), Critical Access Hospitals (CAHs), Emergency medical services (EMS) and trauma, Health disparities and health equity, Healthcare access, Hospitals and clinics, Medicare, Social determinants of health
  • Extent and Coverage of Rural PACE Services
    Supporting independent living and aging in place for rural residents is more important than ever. This project will provide information on the extent and coverage of rural Program of All-Inclusive Care for the Elderly (PACE) programs, along with insights into the unique challenges and opportunities faced by PACE programs operating in rural areas.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Aging, Disabilities, Health disparities and health equity, Healthcare access, Home health, Social determinants of health
  • Federal Agencies' Recent Collaboration and Innovation in Rural Cancer Control: A Model for Practice
    The investigators will conduct an examination of the multi-year effort by the National Cancer Institute to focus on rural cancer issues and its collaboration with the Federal Office of Rural Health Policy. The project will explore the key pieces of evidence that served as the impetus for the emphasis on rural America in cancer control efforts.
    Research center: Southwest Rural Health Research Center
    Topics: Cancer, Health disparities and health equity
  • Geographic and Socio-Demographic Correlates of Medical Debt Among Rural Residents
    Medical debt is widespread and impacts financial well-being and access to care. While research suggests that medical debt is higher among rural residents compared to urban residents, more work is needed to conclusively demonstrate rural/urban differences in medical debt and within-rural risk factors for greater medical debt by geography and socio-demographic characteristics.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Health disparities and health equity, Healthcare access, Poverty, Public health, Rural statistics and demographics, Social determinants of health
  • Hierarchical Condition Category (HCC) Risk Scores: Designed to Predict Future Cost and Health Care Resource Use – Do They Also Accurately Reflect Differences in Health Status between Rural and Urban Beneficiaries?
    This CMS Hierarchical Condition Category (CMS-HCC) risk score study will investigate differences in underlying health between rural and urban populations using recent data and analyze which factors drive observed differences.
    Research center: Rural Health Equity Research Center
    Topics: Health disparities and health equity, Health services, Healthcare access, Hospitals and clinics, Medicaid and CHIP, Medicare, Medicare Advantage (MA)
  • Housing as a Social Determinant of Rural Health
    The purpose of this project is to identify rural/urban and within-rural differences in housing quality and its relationship to health and disability status, especially for individuals living in poverty. We will also identify rural-specific housing issues and innovative policy solutions to address housing challenges in order to improve rural health.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Disabilities, Environmental and agricultural health, Health disparities and health equity, Poverty, Public health, Rural statistics and demographics, Social determinants of health
  • Identifying High-Need Counties for Resource Planning
    The primary aim of this project is to use data examining health care infrastructure, chronic disease prevalence, and the socioeconomic environment to create a metric for classifying rural counties based on needs and resources.
    Research center: Rural and Minority Health Research Center
    Topics: Chronic diseases and conditions, Diabetes, Health disparities and health equity, Healthcare access, Maternal health, Obesity, Oral health, Physicians, Poverty, Public health, Rural statistics and demographics, Social determinants of health, Uninsured and underinsured, Workforce
  • Impact of High Deductible Health Plans on Rural Populations
    Using data from Merative MarketScan insurance claims, this study will investigate utilization, spending, and care patterns of rural members enrolled in high deductible health plans (HDHP) compared to traditional plans. Trends in health outcomes before and after HDHP growth will be assessed to inform policy design tailored to rural residents.
    Research center: Rural and Underserved Health Research Center
    Topics: Health disparities and health equity, Healthcare access, Healthcare financing, Private health insurance, Rural statistics and demographics
  • Palliative Care in the Rural U.S.
    This project will describe the availability of palliative care services in rural hospitals and community settings using data from the American Hospital Association Annual Survey, interviews with palliative care providers, and a survey of rural hospitals without palliative care services.
    Research center: WWAMI Rural Health Research Center
    Topics: Health disparities and health equity, Health services, Healthcare access, Hospice and palliative care, Hospitals and clinics
  • Postpartum Morbidity and Mortality and Health Care Utilization in Rural vs. Urban Communities
    Using 2006-2018 data from the National Health Interview Survey linked to the National Death Index through 2019, this project will examine postpartum mortality among rural and urban residents. We will also evaluate differences in health, health care utilization, and barriers to care across rural and urban communities.
    Research center: University of Minnesota Rural Health Research Center
    Topics: Health disparities and health equity, Healthcare access, Maternal health, Medicaid and CHIP, Mental and behavioral health, Private health insurance, Social determinants of health, Uninsured and underinsured, Women
  • Racial and Ethnic Disparities Shouldered by Rural Americans: Evidence from the Peer-Reviewed and Grey Literature on the Five Leading Causes of Death
    A systematic review of peer-reviewed and grey literature will explore the role of racial and ethnic disparities in the five leading causes of death. The project will provide historical and context setting perspectives on the contributors to the five leading causes of death, particularly as they involve the intersection of rurality and non-majority demographic identities.
    Research center: Southwest Rural Health Research Center
    Topics: Cancer, Chronic diseases and conditions, Health disparities and health equity, Minority health
  • Review of Current Research on Rural/Urban Differences in Social Determinants of Health
    Social determinants of health are social, economic, and community variables that influence health outcomes. This project will synthesize the extant literature on rural/urban differences in the social determinants of health, culminating in a comprehensive report that includes a summary of information gaps and further research needs.
    Research center: Rural and Underserved Health Research Center
    Topics: Health disparities and health equity, Healthcare access, Poverty, Quality, Social determinants of health, Uninsured and underinsured
  • Risky Behaviors and Overdose Deaths Related to Illicit Drug Use
    Using the National Survey on Drug Use and Health, this study will investigate rural vs. urban variations in treatment utilization for alcohol use disorder (AUD) and, separately, drug use disorder (DUD). It will yield prevalence estimates of any treatment receipt and sources of treatment among persons with past year AUD and DUD as well as the receipt of medication therapy among those treatable with medications.
    Research center: Rural and Underserved Health Research Center
    Topics: Health disparities and health equity, Health services, Healthcare access, Mental and behavioral health, Substance use and treatment
  • Risky Substance Use Among Rural and Urban Adults: An Update
    Very little research has examined rural vs. urban differences in substance misuse and treatment access nationally. Using public and nationally representative data from the National Survey on Drug Use and Health, this project will: 1) Estimate and compare alcohol use and binge drinking, and 2) Estimate and compare drug use (marijuana, other illicit drugs, and non-medical use of other drugs) between non-metropolitan and metropolitan adults.
    Research center: Rural and Underserved Health Research Center
    Topics: Health disparities and health equity, Mental and behavioral health, Substance use and treatment
  • Rural and Urban Cancer Survivors' Follow-Up Care Experiences
    This project examines rural vs. urban differences in cancer survivors' follow-up care experiences using the 2017 Medical Expenditure Panel Survey.
    Research center: Rural and Underserved Health Research Center
    Topics: Cancer, Care management, Health disparities and health equity, Health services, Healthcare access, Physicians, Post-acute care, Quality
  • Rural Poverty and Health: A Chartbook
    This chartbook will use nationally representative surveys and county-level data to provide a comprehensive overview of the health and wellbeing of rural Americans living in poverty.
    Research center: Maine Rural Health Research Center
    Topics: Health disparities and health equity, Health services, Healthcare access, Poverty, Rural statistics and demographics
  • Rural-Urban Disparities in Mental Health Access and Quality in the United States
    The purpose of this project is to document the recent trends of mental health care access and quality in urban and rural communities and to assess the intersectionality of residence rurality and race/ethnicity on disparities in mental health care access and quality.
    Research center: Rural and Minority Health Research Center
    Topics: Health disparities and health equity, Healthcare access, Mental and behavioral health
  • Rural/Urban Differences in Forgoing Health Care during the COVID-19 Pandemic
    Several surveys conducted during the COVID-19 pandemic showed that adults delayed or skipped healthcare services during the initial months of the COVID-19 pandemic. This study examines changes in healthcare utilization for primary and preventative care among rural and urban Medicare fee-for-service enrollees since the COVID-19 pandemic.
    Research center: Rural Health Equity Research Center
    Topics: Aging, Care management, Chronic diseases and conditions, Coronavirus Disease 2019 (COVID-19), Diabetes, Health disparities and health equity, Health promotion and disease prevention, Health services, Medicare, Mental and behavioral health, Minority health, Telehealth
  • Rural/Urban Variations in Cancer Screening During the COVID-19 Pandemic
    Using the National Cancer Institute Health Information National Trends Survey, we will examine how the COVID-19 pandemic has disrupted the receipt of recommended screenings for common cancers. Findings will inform policymakers about potential widening of rural/urban disparities in the receipt of cancer preventive services and the potential need to target these services toward rural residents.
    Research center: Rural and Underserved Health Research Center
    Topics: Cancer, Coronavirus Disease 2019 (COVID-19), Health disparities and health equity, Health promotion and disease prevention, Health services, Healthcare access
  • Specialist Physicians in the Rural and Urban U.S.: Supply, Distribution, and Access
    This project will describe the geographic distribution (rural/urban, regional, and intra-rural) of specialist physicians who care for patients experiencing conditions that account for the top four leading causes of rural mortality. It will also explore how patients in rural communities that lack these specialists obtain needed care.
    Research center: WWAMI Rural Health Research Center
    Topics: Cancer, Care management, Chronic diseases and conditions, Frontier health, Health disparities and health equity, Health services, Healthcare access, Physicians, Social determinants of health, Telehealth, Workforce
  • Suicide Mortality: A Comparison of Urban and Rural Rates
    Suicide contributes to significant mortality in the United States. This project will examine the variation in suicide rates by geography and explore its driving factors among urban and rural areas in the United States from 2018 to 2021. The research design of this study will adopt a cross-sectional, retrospective approach, using secondary data.
    Research center: Rural Health Equity Research Center
    Topics: Health disparities and health equity, Healthcare access, Mental and behavioral health, Public health, Rural statistics and demographics, Social determinants of health, Uninsured and underinsured
  • The Impact of Rural Surgery Training on General Surgeon Supply in Rural Communities
    A growing number of general surgery programs offer rural training that aims to address the dwindling supply of rural surgeons. This study aims to describe program models for providing rural general surgery training; quantify the availability of programs; and compare the models' effectiveness in producing rural surgeons.
    Research center: WWAMI Rural Health Research Center
    Topics: Health disparities and health equity, Health services, Healthcare access, Physicians, Workforce
  • Treatment, Provider, and Cost Differences for Rural and Urban Patients with Opioid Use Disorder and Medicaid Insurance Across the U.S.
    This project will analyze Medicaid claims data to compare the treatment that rural and urban patients with opioid use disorder receive, documenting the workforce providing care, the distance that patients travel to receive care, and the cost of care. Findings from this study can be used to improve policies regarding opioid use disorder treatment.
    Research center: WWAMI Rural Health Research Center
    Topics: Health disparities and health equity, Health services, Healthcare access, Healthcare financing, Legislation and regulation, Medicaid and CHIP, Mental and behavioral health, Nurses and nurse practitioners, Pharmacy and prescription drugs, Physician assistants, Physicians, Substance use and treatment, Telehealth, Workforce
  • Trends and Predictors of Urban-Rural and Racial/Ethnic Disparities in Hospitalizations Associated with the Top Five Cancers
    This project will serve to update the Federal Office of Rural Health Policy's cancer research portfolio. Using recent nationally representative hospital discharge data, the researchers will examine trends and predictors of hospitalizations associated with the top five cancers in the U.S.: skin, lung, prostrate, breast, and colorectal.
    Research center: Southwest Rural Health Research Center
    Topics: Cancer, Health disparities and health equity
  • Trends and Predictors of Urban-Rural and Racial/Ethnic Disparities in Hospitalizations Tied to Acute Myocardial Infarction
    This project will update the Federal Office of Rural Health Policy's research portfolio on hospital-based disparities associated with acute myocardial infarctions (AMIs). Very little is known about variances in hospital-based outcomes for AMIs along the urban-rural continuum and among diverse sub-populations in the U.S.
    Research center: Southwest Rural Health Research Center
    Topic: Health disparities and health equity
  • Unmet Health and Social Needs of Rural Residents with Disability
    We will assess rural-urban differences in access to health care and social wellbeing for rural residents with a disability. Disability rates are often higher in rural areas and, given growing evidence of COVID-related disability, this study will provide critical information about the pre-pandemic status of unmet health and social needs among disabled persons to enable future planning.
    Research center: Maine Rural Health Research Center
    Topics: Coronavirus Disease 2019 (COVID-19), Disabilities, Health disparities and health equity, Healthcare access
  • Work Settings, Education, and Intent to Leave Practice among Rural vs. Urban Nurses
    Using data from the 2022 National Nursing Workforce Survey, this project will describe rural/urban differences in nurses' work settings, levels of education and licensure, demographic characteristics, income, and intention to retire or leave practice. Study findings could be applied to implement policies aimed at increasing nursing school output and attracting nurses to practice in rural areas.
    Research center: Rural and Underserved Health Research Center
    Topics: Health disparities and health equity, Nurses and nurse practitioners, Workforce