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Rural-Urban Differences in Usual Source of Care and Ambulatory Service Use: Analyses of National Data Using Urban Influence Codes

Larson, Sharon L. PhD*; Fleishman, John A. PhD*

Original Articles

Background. Rural-urban disparities in access to and utilization of medical care have been a long-standing focus of concern.

Objective. Using the nine-category Urban Influence Codes, this study examines the relationship between place of residence and having access and utilization of ambulatory health services.

Research Design. Data come from the Medical Expenditure Panel Survey, conducted in 1996. Linear and logistic regression analyses assess the relationship between county type and having a usual source of care and ambulatory visits, controlling for demographic and health status measures.

Results. Residents of counties that were totally rural were more likely to report having a usual source of care (adjusted OR: 1.98; CI: 1.01, 3.89) than residents of large metropolitan counties. Residents of places without a city of 10,000 or more, but adjacent to a metropolitan area, were also more likely to report having a usual source of care (adjusted OR: 1.92; CI: 1.16, 3.22). In a regression analysis, residents of the most rural places reported fewer visits during the year (B = -2.42, CI: -3.68, -1.32).

Conclusions. Results suggest that using rural and urban definitions that go beyond the traditional dichotomy of metropolitan and non-metropolitan may assist policymakers and researchers in identifying types of places where there is a disparity in access and subsequent utilization of health care. Rural residents, defined as totally rural in the urban influence coding scheme, may report having a health care provider but report fewer visits to health care providers during a year.

*From the Agency for Healthcare Research and Quality, Rockville, Maryland.

This investigation was supported by the Agency for Healthcare Research and Quality, Rockville, MD.

The views expressed in this article are those of the authors, and no official endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services is intended or should be inferred.

Address correspondence and reprint requests to Dr. Sharon L. Larson, Center for Cost and Financing Studies, 2101 East Jefferson Street, Rockville, Maryland 20852. E-mail:

Copyright © 2003 Wolters Kluwer Health, Inc. All rights reserved.