Category: Research

Data on aging, maternal health, mental health, travel burden

November 4, 2022

Data on aging, maternal health, mental health, travel burden

Rural Health Research Gateway recently compiled research coauthored by multiple NRHA members related to aging in place, race and rurality regarding maternal health disparities, rural mental health, and the travel burden to receive care. Additionally, a recording is available of a recent EMSC Innovation and Improvement Center webinar on optimizing clinical care processes for children and adolescents presenting to the ED with acute suicidality through quality improvement collaboratives. Teams can enroll through Jan. 13. Advocate for the mental health needs of your rural community by joining NRHA and hundreds of rural health stakeholders Feb. 7-9 at NRHA’s 34th Rural Health Policy Institute.

Update on Rural Independently Owned Pharmacy Closures in the United States, 2003-2021

Date: September 1, 2022

Update on Rural Independently Owned Pharmacy Closures in the United States, 2003-2021

Nearly half of rural pharmacies are independently owned retail stores and are susceptible to closing due to financial hardship. This policy brief builds on the history of Rural Policy Research Institute projects examining the provision of pharmacy services and updates pharmacy closure in rural areas of the United States. Monthly data on all institutions providing pharmacy services in the 50 states and District of Columbia were obtained from the National Council for Prescription Drug Programs.

Key Findings:

  • Between 2003 and 2021, the number of retail pharmacies declined in noncore rural areas by 9.8 percent, and in rural micropolitan areas by 4.4 percent, while the number in metropolitan areas increased by 15.1 percent during the same period.
  • Between 2003 and 2021, the number of independently owned retail pharmacies declined in noncore areas by 16.1 percent, and in micropolitan areas by 9.1 percent, while the number in metropolitan areas increased by 28.2 percent during the same period.
  • Between 2003 and 2021, the number of chain pharmacies grew in all three geographies, with the largest growth occurring in metropolitan areas (noncore: 4.6 percent, micropolitan: 3.7 percent, metropolitan: 10.5 percent).
  • Franchise pharmacies have never represented a large segment of the market (1.1 percent of all retail pharmacies in 2021), but their number declined dramatically in all three geographies from 2003 to 2021.

Contact Information:

Keith J. Mueller, PhD
RUPRI Center for Rural Health Policy Analysis
Phone: 319.384.3832
keith-mueller@uiowa.edu

Additional Resources of Interest:

Availability of Home Health, Hospice, and Pharmacy Services in Minoritized Racial/Ethnic Group Areas

Date: August 25, 2022

Availability of Home Health, Hospice, and Pharmacy Services in Minoritized Racial/Ethnic Group Areas

This series of briefs documents disparities in geographic access to health services for ZIP code tabulation areas (ZCTAs) containing a high proportion of minoritized racial/ethnic group (MRG) residents.

Availability of Home Health Services in Minoritized Racial/Ethnic Group Areas

  • In the U.S., home health agency reporting services are not available in 5.9% of all ZCTAs and an additional 10.3% of ZCTAs receive services from a single agency.
  • In 2020, 10.3% of all rural ZCTAs and 2.2% of all urban ZCTAs lacked home health service access. As a ZCTA becomes more rural and remote, these communities are more likely to lack any home health care or have limited service.
  • Within rural ZCTAs in the top 5th percent for minoritized population group representation, non-Hispanic Black representation was less likely to lack all home health services and non-Hispanic American Indian/Alaska Native representation was more likely to lack all home health services when compared to “all other” rural ZCTAs.

Availability of Medicare-Certified Hospice Services in Minoritized Racial/Ethnic Group Areas

  • Centers for Medicare & Medicaid Services-certified hospice providing services are not available in 5.6% of ZCTAs and 14.2% are served by a single hospice.
  • In 2020, 2.4% of all urban ZCTAs had no service while 9.4% of all rural ZCTAs had no service.
  • Within rural ZCTAs in the top 5th percent for minoritized population group representation, American Indian/Alaska Native (32.6%), Asian American/Pacific Islander (12.9%), non-Hispanic white (24.7%), and multiple MRG groups (23.1%) were each more likely than “all other” rural ZCTAs to lack any hospice service (4.5%).

Availability of Pharmacies in Minoritized Racial/Ethnic Areas

  • The mean density of pharmacies across rural ZCTAs was 1.2 pharmacies per 10,000 persons. The mean density of pharmacies across urban ZCTAs was 1.7 pharmacies per 10,000 persons.
  • The lowest density of pharmacies across rural-urban MRG designation was found in rural Hispanic ZCTAs.

Contact Information:

Janice C. Probst, PhD
Rural and Minority Health Research Center
Phone: 803.251.6317
jprobst@mailbox.sc.edu

Additional Resources of Interest:

More information from the Rural Health Information Hub’s topic guides: Healthcare Access in Rural Communities, Rural Home Health Services, Rural Hospice and Palliative Care, Rural Pharmacy and Prescription Drugs

Rural and Urban Pharmacy Presence – Pharmacy Deserts

Date: August 22, 2022

Rural and Urban Pharmacy Presence – Pharmacy Deserts

The purpose of this brief is to examine the availability of community pharmacies and their provided services in rural areas of the U.S. The brief also provides a deeper analysis of counties with no retail pharmacies (i.e., pharmacy deserts) based on metropolitan/nonmetropolitan locations.

In 2021, there were 138 counties with no retail pharmacy, including 101 noncore, 15 micropolitan, and 22 metropolitan counties. By most measures, the proportion of the population considered vulnerable, including nonwhite, uninsured, unemployed, and income below the federal poverty level, is higher in noncore counties with no retail pharmacies than in other counties with no retail pharmacies. Further, the percent of population aged 65 and older and the percent aged 85 and older are higher in noncore and micropolitan counties with no pharmacy than in metropolitan counties.

Despite the possibility of using telepharmacy to improve access to health services in medically underserved regions, only around half of U.S. states have passed legislation authorizing telepharmacy.

Contact Information:

Keith J. Mueller, PhD
RUPRI Center for Rural Health Policy Analysis
Phone: 319.384.3832
keith-mueller@uiowa.edu

Additional Resources of Interest:

Increased Rates of Death from Unintentional Injury Among non-Hispanic White, American Indian/Alaska Native, and Nonmetropolitan Communities

Date: July 25, 2022

Increased Rates of Death from Unintentional Injury Among non-Hispanic White, American Indian/Alaska Native, and Nonmetropolitan Communities

Unintentional injury is the third leading cause of death in the U.S., with an age-adjusted death rate of 48.0 per 100,000 in 2018. The National Hospital Ambulatory Medical Care Survey public use datafile for 2018 was used to generate estimates of nonfatal unintentional injury rates.

Key Findings

  • Visits to the emergency department (ED) for unintentional injuries in 2018 were similar in metropolitan and nonmetropolitan areas.
  • The rate of deaths from unintentional injuries in 2018 was higher in nonmetropolitan areas, compared to metropolitan areas, for all racial/ethnic groups except non-Hispanic Black.
  • Living in a nonmetropolitan area was associated with the largest increase in deaths for those who are American Indian or Alaska Native.
  • Residents of nonmetropolitan areas are more likely than those living in metropolitan areas to suffer a fatal unintentional injury, though there was no difference in the rates of nonfatal unintentional injury ED visits.

Contact Information:

Jeffery Talbert, PhD
Rural and Underserved Health Research Center
Phone: 859.323.7141
jeff.talbert@uky.edu

Additional Resources of Interest:

Nursing Homes in Rural America: A Chartbook

Date: July 14, 2022

A new chartbook is available from the Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis:

Nursing Homes in Rural America: A Chartbook

Hari Sharma; Lili Xu; Fred Ullrich; Clint MacKinney; Keith J. Mueller

Closure of nursing homes and hospitals with swing beds in recent years has changed the availability of post-acute and long-term care services in rural areas. This study examines the availability of post-acute and long-term care services as well as characteristics of residents and nursing homes in noncore, micropolitan, and metropolitan counties.

Please click here to read the brief.

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RUPRI Center for Rural Health Policy Analysis
University of Iowa
College of Public Health
Department of Health Management and Policy
145 Riverside Drive, N200 – CPHB
Iowa City, IA 52242
Phone: (319) 384-3832
Fax: (319) 384-4371

Web site: www.public-health.uiowa.edu/rupri

Follow us on Twitter! @RUPRIhealth

Nursing Homes in Rural America: A Chartbook

Date: July 8, 2022

Nursing Homes in Rural America: A Chartbook

In this chartbook, the Rural Health Research & Policy Centers document nursing home availability at the county level and identify counties without nursing homes. The Rural Health Research & Policy Centers also evaluate the supply of nursing home beds per 1,000 population aged 65 and older. In addition, the Rural Health Research & Policy Centers identify county-level nursing home availability for counties with and without hospitals with swing beds. Finally, the Rural Health Research & Policy Centers describe the resident and nursing home characteristics including occupancy levels, payer mix, demographics, and health care needs. The Rural Health Research & Policy Centers summarize data for the noncore, micropolitan, and metropolitan counties.

Key Findings

  • A lower proportion of noncore counties have nursing home post-acute care and long-term care services. Even the inclusion of hospitals with swing beds does not eliminate the differences in access to post-acute care and long-term care services between noncore counties and metro/micropolitan counties.
  • Many noncore counties have a higher number of nursing home beds per 1,000 population aged 65 and older, particularly in the Midwest. However, differences in the beds per 1,000 population aged 65 and older between noncore counties and metropolitan counties vary by states/regions.
  • Residents of nursing homes in noncore counties are less likely to have functional limitations but are more likely to have behavioral/mental health needs.

Contact Information:

Hari Sharma, PhD
RUPRI Center for Rural Health Policy Analysis
Phone: 319.384.4368
hari-sharma@uiowa.edu

Additional Resources of Interest:

Self-Rated Health Among Gay, Lesbian, and Bisexual Adults: Rural/Urban Differences

Date: July 6, 2022

Self-Rated Health Among Gay, Lesbian, and Bisexual Adults: Rural/Urban Differences

This study examines the intersections of sexual orientation, geographic context, and race/ethnicity and their associations with self-rated health. The Rural Health Research & Policy Centers leveraged three nationally representative and population-based datasets in this brief; the National Health Interview Survey (NHIS), the Behavioral Risk Factor Surveillance System (BRFSS), and the Health Information National Trends Survey.

Key Findings

  • Two national datasets (NHIS and BRFSS) revealed statistically significant differences in self-rated health between rural lesbian, gay, and bisexual (LGB) respondents and heterosexual respondents, with LGB respondents more likely to report fair or poor self-rated health.
  • In multivariable models adjusting for age, sex, race, ethnicity, educational attainment, and income, LGB rural adults had lower likelihood of excellent/very good/good self-rated health, compared with heterosexual rural adults in both the NHIS and the BRFSS datasets.
  • Among rural adults, there were differences in self-rated health by race and ethnicity and sexual orientation.

Contact Information:

Carrie Henning-Smith, PhD, MPH, MSW
University of Minnesota Rural Health Research Center
Phone: 612.626.4512
henn0329@umn.edu

Additional Resources of Interest:

Anxiety, Depression, and Access to Mental Health Care by Sexual Orientation and Rurality

Date: June 30, 2022

Anxiety, Depression, and Access to Mental Health Care by Sexual Orientation and Rurality

The purpose of this policy brief is to illustrate the differences in two of the most common mental health disorders (anxiety and depression) and in access to mental health care by sexual orientation and rurality.

Key Findings

  • Rural lesbian, gay, and bisexual (LGB) adults reported the highest rates of depression and anxiety disorder diagnosis, as well as the highest levels of depressed feelings, compared with urban LGB adults and rural and urban heterosexual adults.
  • Urban LGB adults reported the most barriers to accessing health care.
  • Both rural and urban LGB adults were more likely to have delayed mental health care in the past 12 months because of cost, compared with their heterosexual counterparts.

Contact Information:

Carrie Henning-Smith, PhD, MPH, MSW
University of Minnesota Rural Health Research Center
Phone: 612.626.4512
henn0329@umn.edu

Additional Resources of Interest: