Improving Health Among Rural Residents in the US

Kozhimannil, Katy B.; Henning‐Smith, Carrie

doi:10.1001/jama.2020.26372

Cited by 41 publications

(33 citation statements)

References 4 publications

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“…Our findings have important implications for China and other countries in which the healthcare delivery system is much weaker in rural areas than in urban areas. Rural dwellers are older, more impoverished, and live in sparsely populated areas where medical resources are much less concentrated [ 17 , 46 ]. However, as it is the standard and preferred treatment for AMI, PCI should be equally accessible in rural and urban hospitals.…”

Section: Discussionmentioning

confidence: 99%

The Chasm in Percutaneous Coronary Intervention and In-Hospital Mortality Rates Among Acute Myocardial Infarction Patients in Rural and Urban Hospitals in China: A Mediation Analysis

Cai¹,

Liu²,

Bai³

et al. 2022

Int J Public Health

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Objectives: To determine to what extent the inequality in the ability to provide percutaneous coronary intervention (PCI) translates into outcomes for AMI patients in China.Methods: We identified 82,677 patients who had primary diagnoses of AMI and were hospitalized in Shanxi Province, China, between 2013 and 2017. We applied logistic regressions with inverse probability weighting based on propensity scores and mediation analyses to examine the association of hospital rurality with in-hospital mortality and the potential mediating effects of PCI.Results: In multivariate models where PCI was not adjusted for, rural hospitals were associated with a significantly higher risk of in-hospital mortality (odds ratio [OR]: 1.19, 95% confidence interval [CI]: 1.03–1.37). However, this association was nullified (OR: 0.94, 95% CI: 0.81–1.08) when PCI was included as a covariate. Mediation analyses revealed that PCI significantly mediated 132.3% (95% CI: 104.1–256.6%) of the effect of hospital rurality on in-hospital mortality. The direct effect of hospital rurality on in-hospital mortality was insignificant.Conclusion: The results highlight the need to improve rural hospitals’ infrastructure and address the inequalities of treatments and outcomes in rural and urban hospitals.

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Section: Discussionmentioning

confidence: 99%

The Chasm in Percutaneous Coronary Intervention and In-Hospital Mortality Rates Among Acute Myocardial Infarction Patients in Rural and Urban Hospitals in China: A Mediation Analysis

Cai¹,

Liu²,

Bai³

et al. 2022

Int J Public Health

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“…Policies to address workforce shortages might include incentives for health care providers to work in rural areas, such as loan forgiveness programs; expanded education and training opportunities in rural areas; and addressing scope of practice laws (Rural Health Information Hub, 2017). Broader investment in rural infrastructure, such as expansion of broadband Internet, would also have a positive impact on the availability of rural health care, as well as expanded opportunities for employment, education, and social connectedness in rural areas (Kozhimannil & HenningSmith, 2021).…”

Section: Discussionmentioning

confidence: 99%

“They’re not leaving their home; this is where they were born, this is where they will die.”: Key Informant Perspectives From the U.S. Counties With the Greatest Concentration of the Oldest Old

2021

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The “oldest old,” age 85 and older, constitute one of the fastest growing segments of the U.S. population. Yet, surprisingly little is known about the characteristics of U.S. counties with the highest percentage of the oldest old, nearly all of which are rural. We used qualitative analysis of key informant interviews ( n = 50) with county commissioners and other county-level representatives from rural counties with the highest prevalence of the oldest old, targeting the 54 rural counties with ≥5% of the population age 85+. We found that the rural counties with the highest proportion of residents age 85+ face unique challenges to supporting successful aging among the oldest old, including resource constraints, limited services, isolated locations, and widespread service areas. Still, interviewees identified particular reasons why the oldest old remain in their counties, with many highlighting positive aspects of rural environments and community.

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“…42 In the Western United States, for example, soil and water quality have been influenced by more than 150,000 abandoned hard rock mines, 41 and based on data from the Strong Heart Study (SHS), Native Americans residing in these rural communities have higher urinary heavy metal concentrations than the participants of a more urban/suburban comparison group, the Multi-Ethnic Study of Atherosclerosis (MESA) cohort. 43 Given that 20% of the US population lives in rural areas, 44 and 2% claim Native heritage, 45 this exposure to potentially nephrotoxic metals must be monitored and included in models of risk being developed from clinical data.…”

Section: Ckdmentioning

confidence: 99%