269763 Utility of rural designation in geospatial assessments of distance traveled to healthcare services

Tuesday, October 30, 2012

Matthew Lee Smith, PhD, MPH, CHES , Department of Health Promotion and Behavior, The University of Georgia, College of Public Health, Athens, GA
Justin Dickerson, MBA , Department of Health Policy & Management, Texas A&M Health Science Center, School of Rural Public Health, College Station, TX
Monica L. Wendel, DrPH, MA , Center for Community Health Development, School of Rural Public Health, College Station, TX
SangNam Ahn, PhD, MPSA , Division of Health Systems Management and Policy, The University of Memphis School of Public Health, Memphis, TN
Jairus Pulczinski , School of Rural Health, Texas A&M Health Science Center, College Station, TX
Marcia G. Ory, PhD, MPH , Social & Behavioral Health, Texas A&M HSC School of Rural Public Health, College Station, TX
Background. Our current understanding of rural populations and their health disparities is based largely on research using one of several common taxonomies related to geography and population density. However, these assumed similarities in designation require rigorous testing to assure researchers of their homogeneity when used in health research studies.

Objectives. This study: (1) identified the overlap of various rural designations (e.g., RUCA, MUA, HPSA, frontier) in Central Texas; (2) described participant characteristic profiles based on distance traveled to obtain healthcare services; and (3) examined common profile characteristics associated with each rural designation.

Methods. K-means cluster analysis was used to identify natural groupings of individuals from a community health assessment based on distance traveled to obtain three healthcare services: medical care, dental care, prescription medication pick-up. The resulting clusters were studied for difference using chi-square statistics. Logistic regression analyses were used to identify variation between each rural designation.

Results. All participants in counties designated as frontier also resided in MUA and HPSA. Of those residing in counties not designated as frontier, 58.4% resided in counties designated as MUA and 23.8% resided in counties designated as HPSA. Participants residing in HPSA also resided in MUA; however, 45.4% of those residing in non-designated HPSA also resided in MUA. Significant variation in cluster representation and resident characteristics were observed by rural designation.

Conclusions. Given widely used taxonomies for designating certain areas rural or as provider shortage in public health research, this study highlights important differences that could influence research results based on rural designation.

Learning Areas:
Diversity and culture
Other professions or practice related to public health
Provision of health care to the public
Social and behavioral sciences

Learning Objectives:
1. Identify four ways in which this eight-county region of Central Texas can be divided into different rural designation categories. 2. Identify 3 characteristics of clusters created based on distance traveled to obtain healthcare services. 3. Discuss two ways in which these findings can assist thoughtful study planning, statistical analyses, and finding interpretation in future research related to geography and access to health services.

Keywords: Rural Health, Health Care Access

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been a public health educator and researcher for over a decade. Much of my research and service surrounds rural health issues and associated disparities.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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