Rural-Urban Differences in Health Insurance Coverage and Patterns Among Working-Age Adults in Kentucky

Context: Past studies show that rural populations are less likely than urban populations to have health insurance coverage, which may severely limit their access to needed health services. Purpose: To examine rural-urban differences in various aspects of health insurance coverage among working-age adults in Kentucky. Methods: Data are from a household survey conducted in Kentucky in 2005. The respondents include 2,036 individuals ages 18-64. Bivariate analyses were used to compare the rural-urban differences in health insurance coverage by individual characteristics. Logistic regression analyses were used to examine the independent impact of rural-urban residence on the various aspects of health insurance coverage, while controlling for the individuals’ health status and sociodemographic characteristics. Findings: The overall rate of working-age adults with health insurance did not differ significantly between the rural and urban areas of Kentucky. However, there were significant rural-urban differences in insurance for specific types of health care and in patterns of insurance coverage. Rural adults were less likely than urban adults to have coverage for vision care, dental care, mental health care, and drug abuse treatment. Rural adults were also less likely to obtain insurance through employment, and their current insurance coverage was, on average, of shorter duration than that of urban adults. Conclusions: In Kentucky, the overall health insurance rate of working-age adults is influenced more by employment status and income than by whether these individuals reside in rural or urban areas. However, coverage for specific types of care, and coverage patterns, differ significantly by place of residence.     

Nutrition and health in low income urban areas of the third world†

Data are presented which illustrate the profound differences that exist in health and nutrition status between different income groups in cities of the developing world. The intra‐urban differences cited seem to be greater than urban to rural differences. Adequate services, data collection and program planning is hampered by the inability of decision makers to recognize squatters as official city residents, entitled to municipal services. The dependence on wage income, the instability of employment, and the high residential densities contribute to the onset of disease and malnutrition for the urban squatter family.     

Correlates of health insurance coverage: evidence from the Midwest.

The Midwest is often overlooked in national studies of health insurance status. We analyzed the economic and social characteristics of uninsured and underinsured individuals and households in a Midwestern state using both bivariate and multivariate techniques. As in much of the country, economic factors, particularly income and employment, were most significant in accounting for insurance coverage. Unexpectedly, rural and urban residents were equally likely to lack insurance. Results indicate that in rural areas, underinsurance may be a greater problem than uninsurance, and that income-based health insurance is more effective than employer-provided plans in reaching all Americans.     

Rural-urban differences in access to Iowa child health services.

Indicators of access, utilization, and quality of available child health services as well as health status were obtained through a telephone survey of Iowa households with children under age six. These indicators were compared for rural-urban subsamples within an AFDC sample drawn from Iowa Department of Human Service files (N = 637), and within poverty (N = 129) and nonpoverty groups (N = 631) drawn from the population of all households in the state with children under age six. About 55 percent of all households studied were rural. Rural households were generally larger than urban households, more likely to be intact maritally, white, and earning a living from farming. The findings support the hypothesis that place of residence has an impact on access, utilization, and quality of child health services over and above family income, although not always to the disadvantage of rural children. Typical problems for rural children, irrespective of income, were access to pediatric care, greater travel time to providers, and discontinuity of well care and sick care. Rural children in all income groups had lower seat belt use than urban children; they were also less likely to have well visits and their providers showed less attentiveness to behavioral and developmental issues at these visits. Rural residency exacerbated problems in access to care for low income children, who were less likely to be eligible for AFDC/Medicaid than their urban counterparts. Medicaid coverage, however, did not eliminate rural-urban differences in receiving desired medical care.     

Access to Health Care: Urban-Rural Comparisons from a Midwestern Agricultural State

Lack of access to quality health care for a large number of Americans, particularly those living in rural areas, is a major health care problem. Differences in access between rural and urban areas are caused by obstacles to providing adequate care, such as hospital closures and physician shortages, and low income and/or employment that does not provide health insurance as an employee benefit. This study, based on a random sample of 6,000 households in Nebraska, finds that access to health care is better for residents of rural than urban areas. The relationship holds with controls for health status and health insurance. The pattern in Nebraska reflects an absence of differences in income, health insurance, and health status that produce differences in access between rural and urban areas nationwide. The findings suggest that any serious proposal to reform health care delivery should involve the states and use established patterns of seeking care among state residents.     

Access to and Use of Eye Care Services in Rural Arkansas

Context: Rural residents are more likely to be uninsured and have low income.
Purpose: To determine if rural residents in Arkansas have decreased access to eye care services and use them less frequently than urban residents.
Methods: Data from the 2006 Visual Impairment and Access to Eye Care Module from the Arkansas Behavioral Risk Factor Surveillance System (BRFSS) were used in the analysis. Adults age 40 years and older were included (n = 4,289). Results were weighted to reflect the age, race, and gender distribution of the population of Arkansas. Multiple logistic regression was used to adjust for demographic differences between rural and urban populations.
Findings: Significantly fewer rural residents (45%) reported having insurance coverage for eye care services compared with residents living in urban areas (55%). Rural residents were less likely (45%) than urban residents (49%) to have had a dilated eye exam within the past year. Among residents aged 40-64, those from rural areas were more likely than their urban counterparts to report cost/lack of insurance as the main reason for not having a recent eye care visit.
Conclusions: In 2006, rates of eye care insurance coverage were significantly lower for rural residents while use of eye care services differed slightly between rural and urban residents. Rural residents in Arkansas age 40-64 would benefit from having increased access to eye care insurance and/or low cost eye care services.     

南京地区居民家庭年收入与超重和肥胖关系

目的了解南京地区居民家庭年收入与超重和肥胖的流行病学关系。方法采用横断面方法,研究对象来自南京地区的3个城区和2个乡村、年满35周岁并在当地居住满5年的常住人员。结果超重和肥胖占调查总人数的44.8%,其中超重和肥胖现患率分别为33.0%和11.8%;且在地区和年龄分布中差异有统计学意义,但无性别差异。经多因素调整后,家庭年收入与超重、肥胖的风险之间存在正向的剂量-反应关系;城区居民、女性、50～64岁年龄组、高收入者罹患超重、肥胖的风险越大。结论社会经济状况（家庭收入）与南京地区超重、肥胖关系密切。     

Utilization of Preventive Medical Services in the United States: A Comparison Between Rural and Urban Populations

Differences between rural and urban residents in their utilization of three clinical preventive services--Papanicolaou screening tests (Pap smears) for women aged 18 to 65, mammograms for women aged 50 to 69 and flu shots for people aged 65 or older--were examined using a nationally representative sample from the 1994 U.S. National Health Interview Survey. Eighty-two percent of urban women and 79 percent of rural women (P = 0.11) had Pap smears. Sixty-eight percent of urban women and 61 percent of rural women (P = 0.01) had mammograms. Flu shots were received by 55 percent of urban and 58 percent of rural elderly residents (P = 0.11). Of women aged 50 to 69 who had a high school education or whose annual household income was between $15,000 and $34,999, significantly fewer rural than urban women had mammograms (P < 0.01). However, the proportion of rural women receiving mammograms was not significantly different from that of urban women after adjusting for their education, household income and health insurance status. Education level, house-hold income and health insurance coverage were positively associated with utilizing mammograms. These results suggest that differences in the utilization of preventive services between rural and urban women vary by services. Improving socioeconomic status and health insurance coverage of rural women may reduce the disparity in mammogram use between rural and urban women. Mechanisms of how a woman's socioeconomic status affects her utilization of mammograms needs further study.     

河南省居民卫生服务利用公平性评价

目的 了解河南省居民健康状况、卫生服务利用状况,分析不同收入水平居民卫生服务利用的公平性。方法 利用2013年8-12月第五次国家卫生服务调查中河南省数据,对其中≥15岁的27 140名居民进行分析,运用收入五分组法计算卫生服务利用集中指数（CI）。结果 河南省居民两周患病率为27.37%;其中城市居民为33.43%,农村居民为21.15%;男性为25.65%,女性为28.98%;≥65岁（58.22%）,丧偶（58.93%）,小学及以下学历（38.32%）,离退休（63.99%）,最高与最低收入组居民（31.37%、30.36%）两周患病率较高。居民慢性病患病率为31.50%,城市居民为35.19%,农村居民为27.72%;男性为29.03%,女性为33.82%;≥65岁（75.79%）,丧偶（74.10%）,小学及以下学历（49.94%）,离退休（73.73%）,最低收入组居民（39.80%）两周患病率较高。城市居民两周患病率、慢性病患病率CI值分别为-0.01、0.01;农村居民两周患病率、慢性病患病率CI值分别为-0.05、-0.10。不同城乡分布、性别、年龄、婚姻、文化、就业、人均年收入、医保的居民两周患病就诊率差异均有统计学意义（P<0.001）;城市为25.64%,农村为51.49%;男性为36.64%,女性为34.57%;15~24岁（75.53%）、未婚（54.34%）、技工及中专学历（36.88%）、在校学生（68.89%）两周患病就诊率最高,最高收入组两周患病就诊率最低（30.72%）。不同年龄、收入水平人群应住院而未住院率差异均有统计学意义（P<0.001）,25~34岁（6.39%）和最高收入组（18.43%）应住院而未住院率最低。城乡居民两周患病未就诊率CI值分别为-0.01、0.02;应住院而未住院率CI值分别为-0.05、-0.09。结论 城乡居民住院服务利用均存在不公平性,高收入人群利用的更多,经济困难是限制城乡居民住院服务利用的主要因素。     

Differential correlates of physical activity in urban and rural adults of various socioeconomic backgrounds in the United States

STUDY OBJECTIVES: Few studies have analysed the rates and correlates of physical activity in economically and geographically diverse populations. Objectives were to examine: (1) urban-rural differences in physical activity by several demographic, geographical, environmental, and psychosocial variables, (2) patterns in environmental and policy factors across urban-rural setting and socioeconomic groups, (3) socioeconomic differences in physical activity across the same set of variables, and (4) possible correlations of these patterns with meeting of physical activity recommendations. DESIGN: A cross sectional study with an over sampling of lower income adults was conducted in 1999-2000. SETTING: United States. PARTICIPANTS: 1818 United States adults. Main results: Lower income residents were less likely than higher income residents to meet physical activity recommendations. Rural residents were least likely to meet recommendations; suburban residents were most likely to meet recommendations. Suburban, higher income residents were more than twice as likely to meet recommendations than rural, lower income residents. Significant differences across income levels and urban/rural areas were found for those reporting neighbourhood streets, parks, and malls as places to exercise; fear of injury, being in poor health, or dislike as barriers to exercise and those reporting encouragement from relatives as social support for exercise. Evidence of a positive dose-response relation emerged between number of places to exercise and likelihood to meet recommendations for physical activity. CONCLUSIONS: Both income level and urban rural status were important predictors of adults' likelihood to meet physical activity recommendations. In addition, environmental variables vary in importance across socioeconomic status and urban-rural areas.     

江苏省居民家庭医生服务签约情况及影响因素分析

目的 以江苏省为例，了解居民家庭医生服务签约的情况及其影响因素。方法 利用江苏省第六次卫生服务调查家庭健康调查表中的居民数据进行分析。采用多分类 logistic 回归方法探索家庭医生签约情况的影响因素。结果 9 450例居民中，17.36%的居民已签约家庭医生服务，22.06% 的居民未签约，但知道家庭医生服务，60.58%的居民表示不知道家庭医生服务。logistic结果显示，居民的城乡类型、年龄、收入水平、患慢性病对是否签约家庭医生服务有影响（P＜0.01）；居民的婚姻状态、就业状况、收入水平、到医疗机构最快时间、健康状况评分对是否知道家庭医生服务有影响（P＜0.01）。结论 需要提高居民对家庭医生服务的知晓度；聚焦重点人群，制定个性化服务策略；进一步发挥政策引导作用。     

广州市城乡居民健康行为与生活方式调查

目的了解广州市城乡居民健康相关行为与生活方式现状及其影响因素,为制定社区健康教育项目计划提供依据。方法采用多阶段整群抽样方法,抽取了广州市1920名18～69岁的城乡居民进行问卷调查。结果广州市居民总体健康行为形成率为62．0％,城区居民总体健康行为形成率为77．0％,乡镇居民总体健康行为形成率为47．0％。单项行为形成率最高的是“开窗通风”（95．1％）,最低的是“成年男性控制饮酒量”（21．4％）。城市居民健康行为形成率高于农村居民,不同年龄段、不同职业、不同家庭收入和不同文化程度居民之间的行为形成率差异均有统计学意义（P〈0．01）。结论广州市城乡居民的健康行为与生活方式的形成率总体上有待进一步提高,文化程度、职业、年龄、家庭月平均收入水平等因素影响着健康行为与生活方式的形成。     

我国城乡居民医疗保健支出现状分析

目的 了解我国城乡居民卫生费用及医疗保健支出情况,为完善卫生系统筹资战略提供客观依据.方法 采用1999年至2007年统计年鉴数据,对我国城乡居民卫生费用及医疗保健支出现状及变化趋势进行分析.结果 城乡卫生费用筹资额定比增长了200%;城乡居民人均医疗保健支出增长幅度差异明显(城市为152.86%,农村为172.77%);居民医疗保健支出随人均收入变化而稳步增长,但健康消费总体水平仍很低,尤其是农村居民;2003年以来农村居民医疗保健支出收入弹性比城镇居民大,相对差距正逐步缩小.结论 应重点增加农村居民收入,提高社会边际医疗保健支出倾向;改善医疗卫生服务条件,扩大医疗保障覆盖面,带动城乡居民医疗保健的合理消费;重视文化因素的作用,提高全民健康投资意识和自我保健能力.     

苍南县居民防灾意识及认知水平调查分析

目的了解苍南县居民防灾意识及灾害认知水平,为开展有效的减灾教育,提高公众灾害风险意识和抗灾技能提供依据。方法采用自制调查问卷,对578名居民进行调查。结果居民防灾意识平均得分率为68.40%,防灾意识农村高于城镇,已婚者高于未婚者;文化程度越高,防灾意识越强;不同经济收入居民以平均月收入2000～4999元组防灾意识最强,5000元以上组最低。居民灾害认知水平平均总得分率为76.74%,其中农村高于城镇;年龄小者、文化程度和平均月收入高者,灾害认知水平也高;不同职业居民以医务人员灾害认知水平最高,国家机关、企事业人员次之,商业和服务业人员最低。结论苍南县居民防灾意识和认知水平较低,存在着城乡、年龄、文化程度、婚姻状况、职业状态和不同经济收入水平的差异,应针对不同人群,采取不同的教育方法和重点教育内容,进一步加强灾害风险意识和防灾知识教育。     

Are Rural Residents and Hispanics Less Satisfied With Medical Care? Evidence From the Permian Basin

Few population-based studies of consumers' perceptions of health care quality have included both rural residents and Hispanics. Using data collected through a random-digit telephone survey of households in the Permian Basin region of west Texas, an area with a relatively high percentage of Mexican Americans, we tested for rural/urban and ethnic differences in satisfaction with medical care. The study had several limitations, but the findings suggest that rural residents of this region rate the quality of their medical care overall more negatively than do their urban counterparts. No ethnic differences were found when controlling for demographic, social, economic, and health-status characteristics. Other factors, including part-time employment, a lack of continuous health insurance coverage, and poor health status appear to have a stronger, negative relationship with satisfaction. The collection and reporting of more specific measures of interpersonal and technical quality would further enable policy-makers, managers, and clinicians to better serve their patient populations.     

南京地区社会经济状况和超重肥胖的流行病学研究

[目的]了解南京地区社会经济状况与超重肥胖的流行病学联系。[方法]采用横断面研究,研究对象来自南京地区的3个城区和2个乡村、年满35周岁并在当地居住满5年的常住人员。[结果]超重和肥胖占调查总人数的44.8%,其中超重和肥胖现患率分别为33.0%和11.8%。经多因素调整后,超重肥胖人群在职业、文化、经济分布上的差异均有统计学意义。家庭年收入和职业类型与超重、肥胖正相关;受教育水平与超重肥胖呈负相关。在3个SES指标中,家庭年收入关联最为显著,是应用最广的指标。[结论]社会经济状况与南京地区超重、肥胖关系密切。     

Insurance Coverage of Prescription Drugs and the Rural Elderly

CONTEXT: Rural impacts of a Medicare drug benefit will ultimately depend on the number of elderly who are currently without drug coverage, new demand by those currently without coverage, the nature of the new benefit relative to current benefits, and benefit design. PURPOSE: To enhance understanding of drug coverage among rural elderly Medicare beneficiaries and their expenditures for pharmaceuticals. METHODS: Estimates of the extent of coverage, expenditures, and sources of drugs were obtained using data are from the 1997 Medicare Current Beneficiary Survey and the Pharmacy Verification and Household Components of the 1996 Medical Expenditure Panel Survey. FINDINGS: Three-quarters of the urban elderly had some type of drug coverage in 1997 versus 59% of the elderly in rural areas. Urban residents were more likely to have obtained their drug coverage from an employer-sponsored supplemental plan, and rural residents were more likely to have self-purchased Medigap drug coverage. Expenditures and use of drugs by Medicare beneficiaries are greater for those with than without coverage, and differences are invariant with respect to geographic location. Coverage under self-purchased supplemental plans appears less generous than under employer-sponsored plans in both rural and urban areas. Rural and urban elderly are more than twice as likely to receive at least 1 prescribed medication through the mail than the general population. CONCLUSION: A well-designed Medicare drug benefit would be especially beneficial to the rural elderly because relatively more rural elderly currently lack coverage or have less generous coverage than urban beneficiaries. Mail-order distribution may help contain future program expenditures.     

Regional comparison of dietary intakes and health related behaviors among residents in Asan

Inadequate dietary intakes and poor health behaviors are of concern among rural residents in Korea. This study is conducted to compare dietary intakes, dietary diversity score (DDS), mean nutrient adequacy ratio (MAR) and health related behaviors by rural, factory and urban areas in Asan. A total of 930 adults (351 men and 579 women) were interviewed to assess social economic status (SES), health related behaviors and food intakes by a 24-hour recall method. Mean age was 61.5 years with men being older (64.8 years) than women (59.3 years, p<0.001). Men in the factory area were older than rural or urban men while urban women were the youngest. Education and income of urban residents were higher than other area residents. There were more current drinkers in urban area while smoking status was not different by regions. Physical activity was significantly higher in rural or factory areas, whilst urban residents exercised more often (p<0.05). Rural or factory area residents considered themselves less healthy than others while perceived stress was lower than urban residents. Energy intakes were higher in urban residents or in men, however, after SES was controlled, energy intake did not show any differences. Energy-adjusted nutrient intakes were significantly higher in the urban area (p<0.05) for most nutrients except for carbohydrate, niacin, folic acid, vitamin B₆, iron and fiber. Sodium intake was higher in factory area than in other areas after SES was controlled. DDS of rural men and MAR of both men and women in the rural area were significantly lower when SES was controlled. In conclusion, dietary intakes, diversity, adequacy and perceived health were poor in the rural area, although other health behaviors such as drinking and perceived stress were better than in the urban area. In order to improve perceived health of rural residents, good nutrition and exercise education programs are recommended.     

1999—2007年我国城乡居民卫生保健筹资的趋势比较分析与启示

采用1999-2007年数据对我国城乡居民卫生费用筹资水平、结构及个人医疗保健支出的变化趋势进行比较分析。结果：城乡卫生费用筹资总额所占百分比与人口比例逐年呈现“倒置”现象,农村居民人均卫生费用维持在城镇居民的1／3左右;城镇居民人均医疗保健支出保持为农村居民的3-4倍,二者占人均卫生费用的比重均呈上涨趋势;城乡居民人均医疗保健支出占人均可支配（纯）收入的比重稳步增长（2007年趋于一致：5．07％）,但健康消费总体绝对值水平仍很低,尤其是农村居民;2003年以来农村居民医疗保健支出收入弹性大于城镇居民,城乡相对差距正逐步缩小。基于以上研究提出：重点增加农村居民收入,提高社会边际医疗保健支出倾向;明确政府在医疗卫生领域的经济和监管责任,控制医疗费用快速上涨;改善医疗卫生服务条件,扩大医疗保障覆盖面,带动城乡居民医疗保健合理消费;重视文化因素的作用,提高全民健康投资意识和自我保健能力。