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Member Research & Reports

Member Research & Reports

East Tennessee Discovers Not All “Rural” is Equal

A faculty member in East Tennessee State University’s College of Public Health recently published a paper in conjunction with colleagues from the University of South Carolina examining how the level of health care children receive is affected by where they live.

Earlier this month, the Journal of Community Health published the article “Rural Area Deprivation and Hospitalizations Among Children for Ambulatory Care Sensitive Conditions” by Dr. Nathan Hale, an assistant professor in the department of health services management and policy.

[Photo: Dr. Nathan Hale]

Using hospitalization data from nine states spanning the country, Dr. Hale looked at hospitalizations of children that could have been prevented if timely and appropriate primary care had been given in the first place.

“We know rural communities historically face significant gaps in primary care. Eighty percent of all designated health professional shortage areas are in rural communities. But primary care doesn’t function in a vacuum,” Hale said. “Rural communities tend to experience social and economic vulnerabilities that can be very different from urban areas, so we also constructed an index that told us something about the underlying vulnerability of the communities we were looking at.”

The index was based on five things: unemployment, income, poverty, single-parent homes and education. Hale and his colleagues categorized every county in the nation based on their deprivation index and then examined the intersection of rurality and community area deprivation in those communities being studied.

“What we established is that not all rural communities are equal,” Hale said. “There are some very well off rural communities and some very not well off rural communities.”

Rural communities that are also considered deprived based on the index saw the most significant lack of primary care and higher rates of hospitalization for children.

“We determined there is a gradient in rural communities that you don’t necessarily see when comparing urban communities,” he said. “The more vulnerable you get as a rural community, the more substantial the impact may be and the worse off you are as it relates to health care.”

Rural communities that are highly deprived are most common in the south, with “a considerable number” of counties in Tennessee fitting that profile, Hale noted.

“If you live in an area that doesn’t have a lot of economic opportunities or limited educational opportunities for your children, chances are the primary care capacity in your community may be limited,” he said. “If that is the case, then making sure your child is engaged with whatever capacity is available is important and having them with as routine of a provider that is available is critical in avoiding unnecessary hospitalization, which can be difficult from both a health perspective and a financial perspective.”