Intersection of Living in a Rural Versus Urban Area and Race/Ethnicity in Explaining Access to Health Care in the United States.

OBJECTIVES: To examine whether living in a rural versus urban area differentially exposes populations to social conditions associated with disparities in access to health care. METHODS: We linked Medical Expenditure Panel Survey (2005-2010) data to geographic data from the American Community Survey (2005-2009) and Area Health Resource File (2010). We categorized census tracts as rural and urban by using the Rural-Urban Commuting Area Codes. Respondent sample sizes ranged from 49 839 to 105 306. Outcomes were access to a usual source of health care, cholesterol screening, cervical screening, dental visit within recommended intervals, and health care needs met. RESULTS: African Americans in rural areas had lower odds of cholesterol screening (odds ratio[OR] = 0.37; 95% confidence interval[CI] = 0.25, 0.57) and cervical screening (OR = 0.48; 95% CI = 0.29, 0.80) than African Americans in urban areas. Whites had fewer screenings and dental visits in rural versus urban areas. There were mixed results for which racial/ethnic group had better access. CONCLUSIONS: Rural status confers additional disadvantage for most of the health care use measures, independently of poverty and health care supply.

Relationship between a Centers for Disease Control and Prevention expanded HIV testing initiative and past-year testing by race/ethnicity: a multilevel analysis of the Behavioral Risk Factor Surveillance System.

The Centers for Disease Control and Prevention's (CDC) expanded testing initiative (ETI) aims to bolster HIV testing among populations disproportionately affected by the HIV epidemic by providing additional funding to health departments serving these communities. ETI prioritizes testing in clinical settings; therefore, we examined the relationship between state-level ETI participation and past-year HIV testing among a racially/ethnically diverse sample of adult respondents to the 2012 Behavioral Risk Factor Surveillance System who accessed health services within the 12 months prior to being interviewed. Controlling for individual- and state-level characteristics in a multilevel logistic regression model, ETI participation was independently and positively associated with past-year testing, but this association varied by race/ethnicity. Hispanics had higher odds (adjusted odds ratio [AOR]: 1.49; 95% CI: 1.11-2.02) and American Indian/Alaska Natives had lower odds (AOR: 0.66; 95% CI: 0.43-0.99) of testing if they resided in states with (vs. without) ETI participation. State-level ETI participation did not significantly alter past-year testing among other racial/ethnic groups. Prioritizing public health resources in states most affected by HIV can improve testing patterns, but other mechanisms likely influence which racial/ethnic groups undergo testing.

Racial/Ethnic Inequities in Access to High-Quality Dialysis Treatment in Chicago: Does Neighborhood Racial/Ethnic Composition Matter?

OBJECTIVES: Blacks and Hispanics face a higher incidence rate of end-stage renal disease (ESRD) and tend to experience poorer access to quality health care compared with Whites. Income, education, and insurance coverage differentials are typically identified as risk factors, but neighborhood-level analyses may provide additional insights. We examine whether neighborhood racial composition contributes to racial/ethnic inequities in access to high-quality dialysis care in Chicago. METHODS: Data are drawn from the United States Renal Data System merged to the ESRD Quality Incentive Program file and the American Community Survey (2005-2009) for facility and neighborhood characteristics (N = 2797). Outcomes included (1) spatial access (travel time to dialysis facilities) and (2) realized access (actual use of quality care). Neighborhood racial/ethnic composition was categorized into four types: predominantly White, Black, and Hispanic neighborhoods, and racially integrated neighborhoods. RESULTS: Blacks lived closer to a dialysis facility but traveled the same distance to their own dialysis compared with Whites. Hispanics had longer travel time to any dialysis than Whites, and the difference between Hispanics and Whites became no longer significant after adjusting for neighborhood racial/ethnic composition. Blacks and Hispanics had better access to a high-quality facility if they lived in integrated neighborhoods (OR = 1.85 and 3.77, respectively, p < 0.01) or in neighborhoods with higher concentrations of their own race/ethnicity (OR = 1.68 for Blacks in Black neighborhoods and 1.92 for Hispanics in Hispanic neighborhoods, p < 0.05) compared with Whites in predominantly White neighborhoods. CONCLUSION: Expanding opportunities for Blacks and Hispanics to gain access to racially integrated and minority neighborhoods may help alleviate racial/ethnic inequities in access to quality care among kidney disease patients.

Disablement in Context: Neighborhood Characteristics and Their Association With Frailty Onset Among Older Adults.

OBJECTIVES: Frailty, an aggregate expression of risk resulting from age- or disease-associated physiologic accumulation, is responsible for large economic and societal costs. Little is known about how the context in which older adult's live may contribute to differences in frailty. This study clarifies the role of neighborhood structural characteristics and social processes for understanding declines in health status. METHOD: Data from two waves of the National Social Life, Health and Aging Project were linked to tract-level information from the 2000 Census (n = 1,925). Frailty was measured with in-home assessments and self-report. Ordered logistic regressions were employed to estimate the role of tract-level structural and social process indicators at baseline on frailty at follow-up. RESULTS: Living in a neighborhood characterized with a higher density of African Americans and with more residential instability was associated with higher odds of frailty. Adults in neighborhoods with increasing levels of physical disorder had higher odds of frailty (adjusted odds ratio [AOR]: 1.20, 95% confidence interval [CI]: 1.03, 1.39), while those exposed to more social cohesion had lower odds (AOR: 0.87, CI: 0.78, 0.97). DISCUSSION: For older adults, both neighborhood structural and social process characteristics appear to be independently associated with frailty.

The Role of Primary Care for the Oral Health of Rural and Urban Older Adults.

CONTEXT: Rural populations often have restricted access to dental care and poor oral health. These problems may disproportionately affect older blacks in rural areas. Little is known about how access to primary health care may improve the oral health of rural seniors. PURPOSE: This study examines whether the relationship between having a usual source of health care and oral health varies for white and black older adults in rural and urban areas in the United States. METHODS: We draw on cross-sectional data of adults (50 years+) from the nationally representative Health and Retirement Study (n = 15,473). Multivariate logistic regression examined the role of a usual source of health care in conditioning racial differences in complete tooth loss and a dental visit in the past 2 years. A usual source of health care is a place, not including an emergency room, where a person goes when he or she is sick or needs health advice. FINDINGS: In rural areas, blacks had high rates of tooth loss (28%) and low rates of dental visits (34%). Having a usual source of health care was associated with higher odds of a dental visit for all adults. In rural areas, the association between a usual source of health care and tooth loss varied by race (P < .001); blacks had more tooth loss than whites even with a usual source of health care. CONCLUSIONS: Access to primary health care was associated with improved oral health outcomes, but it did not close the gap between whites and blacks in rural areas.

Racial and ethnic residential segregation and access to health care in rural areas.

This study examined the relationship between racial/ethnic residential segregation and access to health care in rural areas. Data from the Medical Expenditure Panel Survey were merged with the American Community Survey and the Area Health Resources Files. Segregation was operationalized using the isolation index separately for African Americans and Hispanics. Multi-level logistic regression with random intercepts estimated four outcomes. In rural areas, segregation contributed to worse access to a usual source of health care but higher reports of health care needs being met among African Americans (Adjusted Odds Ratio [AOR]: 1.42, CI: 0.96-2.10) and Hispanics (AOR: 1.25, CI: 1.05-1.49). By broadening the spatial scale of segregation beyond urban areas, findings showed the complex interaction between social and spatial factors in rural areas.

Does Attending Worship Mitigate Racial/Ethnic Discrimination in Influencing Health Behaviors? Results From an Analysis of the California Health Interview Survey.

Existing research suggests that religious institutions play a significant role in improving the health of communities, particularly those coping with racial and ethnic discrimination. Using the California Health Interview Survey, this article examines the relationship of self-reported experiences of racial/ethnic discrimination, worship attendance, and several health behaviors. Supporting existing research, higher self-reported racial/ethnic discrimination is associated with worse health behaviors. Logistic regression models indicate that the odds of engaging in healthy lifestyle behaviors significantly increase for those who report attending worship, compared with those who do not attend worship, with variations by race/ethnicity. Worship attendance moderates the association between discrimination and binge drinking, but does not moderate the association for smoking, walking, or being obese. Findings suggest that religious attendance plays an important role in the health and well-being of all population groups. More research is needed to ascertain the reasons why attending worship may have the ability to mitigate the relationship between racial/ethnic discrimination and health.