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APHA Scientific Session and Event Listing

Recorded presentation

Margaret Jean Hall, PhD and Maria F. Owings, PhD. National Center for Health Statistics, Centers for Disease Control and Prevention, 3311 Toledo Road, Room 3227, Hyattsville, MD 20782, 301-458-4409, mowings@cdc.gov

Research Objective: To explore differences in the characteristics of rural and urban aging patients 65 and over hospitalized for respiratory diseases. Study Design: Data are from the 2003 National Hospital Discharge Survey, a nationally representative survey of short-stay, nonfederal US hospitals. Aging patients hospitalized for respiratory conditions (codes 460-519 in the International Classification of Diseases, 9th Revision, Clinical Modification) were studied. Patient ZIPcodes were linked with county FIPS codes, then with Area Resource File data on counties' socio-economic status (SES) and health services availability. Using OMB definitions based on the 2000 Census, metropolitan counties were classified as urban and all others (micropolitan and noncore) as rural. Logistic regression will identify patient and county characteristics which predict rural and urban respiratory hospitalization. Preliminary Findings: The respiratory hospitalization rate per 10,000 population was 64% higher for rural (711) than urban (434) aging patients. The rural rate of potentially avoidable respiratory hospitalizations, i.e. pneumonia and asthma, was 89% higher (392 vs. 207). The average age for both groups was 79. Rural inpatients were more likely to live in counties with lower SES, less HMO penetration, and fewer active MD's. Characteristics which distinguish between rural and urban aging respiratory inpatients will be identified using multivariate analyses. Conclusions: Causes of the large rural/urban differences observed here are numerous, and include well-documented physician and other primary care shortages in rural areas and regional variation in chronic conditions and overall health status. Results reported here can lead to health policies which could reduce these disparities.

Learning Objectives:

• Recognize that national data show that rural aging patients are hospitalized at a much higher rate for respiratory diseases than urban aging patients.
• Understand the patient and county-level factors that differentiate between aging respiratory hospitalized patients from urban and rural areas.
• Assess the extent to which the higher rural hospitalization rates appear to be due to avoidable hospitalizations, that is, those which potentially could have been avoided if appropriate and timely primary care was received.
• Initiate actions that can be taken at the local level to identify patients at high risk of avoidable hospitalizations and to decrease these hospitalizations. Some examples include outreach programs to educate patients about available financial assistance for care not fully covered by Medicare or other insurance, encouragement and assistance signing up for Medicare Part D outpatient drug coverage, education about the coverage and benefits of influenza and pneumonia shots and the dangers of smoking, and the importance of not delaying doctor visits for respiratory symptoms.
• Identify state and national health policy changes which could help reduce the disparities between urban and rural aging respiratory patients including more generous Medicaid coverage of drugs and primary care, more free and low cost rural health clinics, studies of the air quality in rural versus urban areas.

Keywords: Rural Health Care, Health Disparities

Awards: Excellence in Aging and Rural Health - Recipient

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation