Health disparities and health equity

Research Products

Listed by publication date. You can also view these publications alphabetically.

2020

  • Post-Acute Skilled Nursing Care Availability in Rural United States
    Policy Brief
    Southwest Rural Health Research Center
    Date: 07/2020
    This policy brief explores factors related to variations in the availability of post-acute skilled nursing care in rural areas in the U.S. The focus of this analysis is on swing bed program hospitals and skilled nursing facility post-acute skilled nursing care.
  • Major Depression, Treatment Receipt, and Treatment Sources Among Non-Metropolitan and Metropolitan Adults
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 06/2020
    This study estimates and compares the prevalence of past year depression, receipt of treatment for depression, and sources of treatment for depression between non-metropolitan and metropolitan adults.
  • Supporting the Health and Wellbeing of Middle-Aged Adults Living Alone in Rural Counties
    University of Minnesota Rural Health Research Center
    Date: 06/2020
    This report shares insights from healthcare providers in 14 rural counties with the highest rates of middle-aged adults living alone in order to inform policy and practice in how best to support the health and well-being of this demographic.
  • Characteristics of Counties with the Highest Proportion of the Oldest Old
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 05/2020
    The "oldest old," or individuals age 85 and older, are one of the fastest-growing segments of the U.S. population, yet little is known about where those individuals tend to live and what their communities are like. This information is important for planning how to best respond to and support this growing population.
  • Rural-Urban Residence and Mortality Among Three Cohorts of U.S. Adults
    Policy Brief
    Maine Rural Health Research Center
    Date: 05/2020
    Rural residents have a shorter life expectancy than urban residents. We analyzed national linked survey and death certificate data and found risk of death was 10% higher for rural than urban residents and has increased over time. Findings suggest the overall mortality penalty in rural areas may be partly driven by social determinants of health.
  • Rates of Living Alone by Rurality and Age
    University of Minnesota Rural Health Research Center
    Date: 04/2020
    In this infographic, we identify rates of living alone for all adults and within specific age groups using two classifications of rurality.
  • Healthy People 2020 Progress for Leading Causes of Death in Rural and Urban America: A Chartbook
    Chartbook
    Southwest Rural Health Research Center
    Date: 03/2020
    The purpose of this project is to conduct a midterm examination of urban versus rural disparities in meeting Healthy People 2020 mortality objectives for the top 10 leading causes of death in the U.S.
  • Health Care Use and Access Among Rural and Urban Nonelderly Adult Medicare Beneficiaries
    Policy Brief
    Maine Rural Health Research Center
    Date: 01/2020
    Little is known about the characteristics and healthcare use of rural residents with disabilities. This study compares access to and use of health services among rural and urban nonelderly Medicare beneficiaries with a disability and the factors associated with rural access issues.

2019

  • Partial Psychiatric Hospitalization Program Availability in Nonmetropolitan and Metropolitan Hospitals Nationally
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 12/2019
    Partial psychiatric hospitalization programs (PPHPs) are intended to reduce or avoid inpatient stays by providing intensive psychiatric services in outpatient settings. We provide national estimates of PPHP availability among nonmetropolitan and metropolitan hospitals and describe the hospital characteristics associated with the provision of PPHPs.
  • 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.
  • Prevalence and Mortality of Heart Disease and Related Conditions: Disparities Affecting the South, Rural Areas, and American Indian and Alaska Natives
    Policy Brief
    Southwest Rural Health Research Center
    Date: 11/2019
    This policy brief identifies trends in the prevalence of stroke, heart disease, and heart attack while also assessing trends in mortality for heart disease and related conditions across the nation. The study examined whether disease-related mortality and prevalence varied across place and time.
  • Severe Maternal Morbidity and Hospital Transfer Among Rural Residents
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 11/2019
    In this brief, we compare hospital transfer rates for rural and urban residents who gave birth. We also provide descriptive information about the relationship between transfer status and severe maternal morbidity and mortality for rural residents nationally who gave birth 2008-2014.
  • Risk Factors and Potentially Preventable Deaths in Rural Communities
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 10/2019
    In this study, we use variation in three risk factors – smoking, obesity, and excessive alcohol use – to identify their relative contribution to common causes of mortality.
  • Suicidal Thoughts, Plans, and Attempts by Non-Metropolitan and Metropolitan Residence
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 05/2019
    Suicide is among the leading causes of death in the US, and rates in non-metropolitan (rural) counties have historically exceeded those in metropolitan (urban) counties. This study examined the prevalence of suicidal thoughts, plans, and attempts by year (2010-2016) and county type (non-metropolitan, small metropolitan, and large metropolitan).
  • Comparing Rural and Urban Medicare Advantage Beneficiary Characteristics
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 03/2019
    This brief reports few rural and urban differences in observed demographic characteristics among enrollees in the Medicare Advantage program. Issuers often exclude rural counties from their service areas, but we find no evidence that this is due to such demographics, suggesting that other reasons relating to population size may be more likely.
  • 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.
  • Do Hospital Closures Affect Patient Time in an Ambulance?
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 02/2019
    Our study explores how a local hospital closure changes patient time in an ambulance for 9-1-1 calls. Access to emergency department services in communities, especially rural communities, persists as a priority for the Medicare program. We found when hospitals close, rural patients requiring ambulance services are disproportionately affected.

2018

  • Cancer Mortality in Rural America: 1999-2016
    Policy Brief
    Southwest Rural Health Research Center
    Date: 11/2018
    This policy brief details the differences in mortality from cancer at various levels of rurality in America. The primary aim of this study was to understand the scope of cancer mortality in urban and rural areas of the U.S. Common cancer types—breast, cervical, lung, prostate, and colon—were analyzed over an 18-year period from 1999-2016.
  • Update: Rural/Urban Disparities in Pneumococcal Vaccine Service Delivery Among the Fee-for-Service Medicare Population, 2012-2015
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 11/2018
    Delivery of pneumococcal vaccines to fee-for-service Medicare beneficiaries increased 380% from 2014-2015 as a result of uptake of pneumococcal conjugate vaccine (PCV13). However, a significant rural-urban disparity remains. Pharmacy providers delivered a significantly greater proportion of vaccines in rural versus urban counties.
  • Medicaid Managed Care and the Rural Exception: A Review of Issues and Perspectives from the Field
    Policy Brief
    Rural and Minority Health Research Center
    Date: 05/2018
    To examine the intersection of state Medicaid procedures with rural populations, we conducted a review of Medicaid waivers current as of September 2017. This was supplemented with calls to State Offices of Rural Health (SORHs), state Medicaid offices, and other relevant stakeholders in an attempt to understand the process of waiver development.
  • Diabetes-Related Hospital Mortality in Rural America: A Significant Cause for Concern
    Policy Brief
    Southwest Rural Health Research Center
    Date: 03/2018
    This brief is the third in a series prepared by the Southwest Rural Health Research Center on the topic of diabetes. The aim of this study was to examine trends and rates of diabetes-related deaths for persons hospitalized in the U.S., with emphasis on differences across the urban-rural continuum and across census regions.
  • Rural Family Physicians Have a Broader Scope of Practice Than Urban Family Physicians
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 02/2018
    While the scope of practice of family physicians has been shrinking, they still practice broadly, often due to fewer health care resources in rural areas. Using data from family physicians seeking continued board certification in 2014 and 2015, we found that a high percentage of rural family physicians provide nearly every clinical service queried.
  • Rural Family Physicians in Patient Centered Medical Homes Have a Broader Scope of Practice
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 02/2018
    The Patient Centered Medical Home (PCMH) is supposed to provide accessible and comprehensive care. Using data from family physicians seeking to continue their American Board of Family Medicine certification in 2014 and 2015, we found that rural family physicians in PCMH practices generally provide more services than those in non-PCMH practices.
  • Rural/Urban Disparities in Pneumococcal Vaccine Service Delivery Among the Fee-for-Service Medicare Population
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 02/2018
    Using 2014 Medicare data, we found a significant disparity in pneumococcal vaccine service delivery to fee-for-service Medicare beneficiaries. Although primary care providers delivered the majority of pneumococcal vaccines to this population, pharmacy providers delivered a significantly greater proportion of vaccines in rural versus urban counties.
  • Illicit Drug and Opioid Use Disorders Among Non-Metropolitan Residents
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 01/2018
    We provide estimates of the prevalence of illicit drug and opioid use disorders among non-metropolitan adults ages 18-64. Prevalence rates did not decline from 2011-2013 to 2014-2015 despite the implementation of major substance use treatment policies. Of particular concern, heroin use disorder prevalence increased in recent years.
  • Perceived Treatment Need and Utilization for Illicit Drug and Opioid Use Disorders in Non-Metropolitan Areas
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 01/2018
    The vast majority of non-metropolitan adults 18-64 who satisfy criteria for an illicit drug use or opioid use disorder do not perceive a need for treatment or receive formal substance use treatment. Despite policies to increase treatment access during the 2008-2015 study period, we found few changes in perceived treatment need and utilization.

2017

  • Ambulance Services for Medicare Beneficiaries: State Differences in Usage, 2012-2014
    Policy Brief
    Rural and Underserved Health Research Center
    Date: 10/2017
    Ambulance services are at risk of scaling back or dissolving in some places. We analyzed Medicare beneficiaries' use of ambulance services across the U.S. Improved understanding of how beneficiaries, most of whom are elderly, use these services provides vital information for policymakers who set rules and regulations about access to the services.
  • Diabetes and Forgone Medical Care due to Cost in the U.S. (2011-2015): Individual-level and Place-based Disparities
    Policy Brief
    Southwest Rural Health Research Center
    Date: 08/2017
    This brief is the first in a series prepared by the Southwest Rural Health Research Center on the topic of diabetes. The two aims of this study were to identify trends in diabetes rates and forgone medical care among persons with diabetes in the U.S. and to identify geographic determinants and other social determinants of health disparities.
  • Diabetes Mortality in Rural America: 1999-2015
    Policy Brief
    Southwest Rural Health Research Center
    Date: 08/2017
    This brief is the second in a series prepared by the Southwest Rural Health Research Center on the topic of diabetes. The primary aim of this study was to understand the scope of diabetes-related mortality in urban and rural America. We analyzed mortality caused by diabetes over a 16-year period and explored the roles played by rurality and race.
  • Regional Differences in Rural and Urban Mortality Trends
    Policy Brief
    North Carolina Rural Health Research and Policy Analysis Center
    Date: 08/2017
    This brief explores the differences in mortality rates over time by (1) urban and rural location, (2) census division, and (3) urban and rural location within each census division.
  • Rural/Urban Analysis on Individual Insurance Market Topics
    Fact Sheet
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2017
    Some special challenges face the development and sustainability of marketplace plans in rural areas. This data release provides some additional detail on some important topics, with particular importance to rural people, places, and providers.
  • Rural Health Snapshot (2017)
    Rapid Response to Requests for Rural Data Analysis
    Date: 05/2017
    The Rural Health Snapshot (2017) updates the 2010 Rural Health Snapshot. The document is a data sheet that compares a selection of health and healthcare access indicators for populations in rural and urban areas.
  • 2016 Rural Enrollment in Health Insurance Marketplaces, by State
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 01/2017
    Cumulative county-level enrollment rates in Health Insurance Marketplaces (HIMs) in metropolitan and non-metropolitan areas of each state, defined as the percentage of "potential market" participants selecting plans, are presented as of March 2016. States are separated by Medicaid expansion status.

2016

  • Community Factors and Outcomes of Home Health Care for High-Risk Rural Medicare Beneficiaries
    Policy Brief
    WWAMI Rural Health Research Center
    Date: 10/2016
    Outcomes of care vary by region of the country for rural Medicare beneficiaries receiving home health services for high-risk conditions such as heart failure. Those in the East South Central and West South Central Census Divisions had lower rates of community discharge and higher rates of hospital readmission and emergency department use.
  • Health Insurance Marketplaces: Premium Trends in Rural Areas
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2016
    Total Health Insurance Marketplace premiums have grown disproportionately in rural places in 2016. Urban counties have an average of 4.2 firms, while rural counties average 3.2 firms offering coverage through the HIMs. This causes concern since, at the county level, we find that as the number of firms increases, premiums increase at a slower rate.
  • Exploring Rural and Urban Mortality Differences
    North Dakota and NORC Rural Health Reform Policy Research Center
    Date: 03/2016
    Contains visual aids which display indicators of mortality rates by cause of death, age group, rural-urban status, region, and sex for populations 15 years of age and older cross-referenced to tables and statistical results.
  • Rural Opioid Abuse: Prevalence and User Characteristics
    Policy Brief
    Maine Rural Health Research Center
    Date: 02/2016
    Opioid abuse is the fastest growing substance abuse problem in the nation and the primary cause of unintentional drug overdose deaths. This study examined the rural-urban prevalence of non-medical use of pain relievers and heroin in the past year and the socioeconomic characteristics associated with their use and other risky behavior.

2015

  • Area Deprivation is Higher Among Rural Counties - But Not All Rural Counties are Deprived
    Policy Brief
    Rural and Minority Health Research Center
    Date: 08/2015
    This brief is one of two on the role of residence/community deprivation on potentially avoidable hospitalizations (PAH) of children. It details development of an area deprivation index, examines area deprivation across all U.S. counties, and describes findings when applied to rates of PAH among a nine-state sample of children.
  • The Intersection of Residence and Area Deprivation: The Case of Hospitalizations from Ambulatory Care Sensitive Conditions Among Children
    Policy Brief
    Rural and Minority Health Research Center
    Date: 08/2015
    This brief is the second in a series providing information on the role of residence and community deprivation on potentially avoidable hospitalizations among children. This brief describes the findings from a nine-state sample of children's hospitalizations and discusses the potential implications for rural health research and policy.
  • Perspectives of Rural Hospice Directors
    Policy Brief
    North Dakota and NORC Rural Health Reform Policy Research Center
    Date: 03/2015
    Rural hospice care is under pressure by a variety of factors that are reviewed in this document. However, a central core element of rural hospice remains the strong sense of community that is embodied in the system and design of care. This policy brief is the result of a national phone survey of rural hospice directors or key staff in 47 states.
  • Use and Performance Variations in U.S. Rural Emergency Departments: Implications for Improving Care Quality and Reducing Costs
    Policy Brief
    North Dakota and NORC Rural Health Reform Policy Research Center
    Date: 02/2015
    This brief describes the variation in emergency department use for non-emergent health conditions across rural and urban areas as well as by U.S. Census regions. Potential risk factors, including patients' socioeconomic characteristics and levels of primary care resources, are identified. Quality of care indicators are also addressed.

2014

  • The 2014 Update of the Rural-Urban Chartbook
    Chartbook
    North Dakota and NORC Rural Health Reform Policy Research Center
    Date: 10/2014
    This chartbook includes trends and disparities in urban/rural health. Reports on population characteristics include age, race and ethnicity, and poverty; risk factors such as smoking, alcohol use, and obesity; mortality data; health status measures such as adolescent births and total tooth loss; healthcare access/use; and mental health measures.
  • Rural-Urban Disparities in Heart Disease
    Policy Brief
    North Dakota and NORC Rural Health Reform Policy Research Center
    Date: 10/2014
    The Department of Health and Human Services' report Health, United States, 2001: With Urban and Rural Health Chartbook illustrated trends and highlighted priorities in urban/rural health. The Rural Health Reform Policy Research Center replicated the analyses using the most recent data available. This brief highlights key heart disease findings.

2013

  • Demographic and Economic Characteristics Associated with Sole County Pharmacy Closures, 2006-2010
    RUPRI Center for Rural Health Policy Analysis
    Date: 11/2013
    This policy brief describes demographic and economic characteristics associated with counties experiencing closure of their sole pharmacy.
  • Inadequate Prenatal Care Among Racial and Ethnic Groups in the Rural United States, 2005
    WWAMI Rural Health Research Center
    Date: 10/2013
    This brief reports that in most states, rural minority racial/ethnic groups had levels of inadequate prenatal care (less than 50% of expected visits) in the "worst" or "worse than mid-range" categories.
  • Inadequate Prenatal Care in the Rural United States, 2005
    WWAMI Rural Health Research Center
    Date: 10/2013
    This policy brief finds that the states with levels of rural inadequate prenatal care (less than 50% of expected visits) in the "worst" or "worse than mid-range" categories were largely in southern and southwestern areas of the United States.
  • Low Birth Weight Rates Among Racial and Ethnic Groups in the Rural United States, 2005
    WWAMI Rural Health Research Center
    Date: 10/2013
    Reports that non-hispanic blacks generally had the highest rural low birth weight rates of all races/ethnicities, regardless of geographic location.
  • Low Birth Weight Rates in the Rural United States, 2005
    WWAMI Rural Health Research Center
    Date: 10/2013
    This brief shares that the rural U.S. low birth weight rate in 2005 was significantly higher than the urban U.S. low birth weight rate.
  • Dialysis Availability in Rural America
    Rural and Minority Health Research Center
    Date: 01/2013
    This study explores the availability of dialysis services in rural America, including the prevalence of dialysis use across urban and rural counties, travel distance for services, and dialysis quality outcomes.
  • Rural Border Health Chartbook
    Rural and Minority Health Research Center
    Date: 01/2013
    The chartbook examines potential geographic and ethnic disparities among U.S. border residents and describes select indicators related to access to care, women's preventive services, oral health, infectious and communicable diseases, and mental health that have been identified as disparities.
  • Rural Border Health Chartbook (Key Facts)
    Rural and Minority Health Research Center
    Date: 01/2013
    This report examines potential geographic and ethnic disparities among U.S. border residents and describes select indicators related to access to care, women's preventive services, oral health, infectious and communicable diseases, and mental health that have been identified as disparities.

2011

2008

2007

2006

2005

2004

2003

2002

2001

2000