Significant healthcare disparities exist between rural and non-rural children

1. Compared with non-rural children, rural children had higher rates of medically complex chronic conditions, required medical technology assistance, and resided in low-income ZIP codes.

2. Rural children experienced higher odds of readmission and had more expensive hospitalizations compared with non-rural children.

Evidence Rating Level: 2 (Good)       

Study Rundown: Previous research has demonstrated that rural children experience worse health outcomes compared to those living in more densely populated areas. Recently, this issue has gained political attention with the launch of the “Rural Impact” initiative to bridge the gap in healthcare disparities among rural children. This study used a nationally representative sample to characterize the needs and utilization of healthcare among rural children. Retrospective data on pediatric hospital admissions for the 2012 calendar year were analyzed, using ZIP codes to assess rurality. About half of rural children lived in a low-income ZIP code and a fifth were in a Health Professional Shortage Area (HPSA). A greater proportion of rural children suffered from complex chronic health conditions and required medical technology assistance. Rural children also experienced higher inpatient costs and readmission rates. While this study gives a detailed nationally representative snapshot of rural children’s characteristics and healthcare needs and utilization, these findings are limited by generalization strictly to freestanding children’s hospitals. Clinically, these findings hold significance as children’s hospitals increase their efforts in meeting the needs of their more rural catchment areas.

Click to read the study, published today in Pediatrics

Relevant Reading: Rural/urban differences in barriers to and burden of care for children with special health care needs

Study Author, Dr. Alon Peltz, MD, MBA, talks to 2 Minute Medicine: Robert Wood Johnson Clinical Scholar, Yale University, New Haven, CT; Department of Pediatrics, Boston Medical Center, Boston, MA

“Rural children hospitalized at children’s hospitals were more often readmitted to the hospital following discharge than were non-rural children.  Many rural children were discharged to areas with a shortage of local health care services and high levels of poverty.  New and innovative approaches are needed to better connect children’s hospitals and rural health care professionals.”

In-Depth [retrospective cohort]: This study included all 2012 admissions (N = 672,190) to 41 freestanding children’s hospitals across the US, collected from the Pediatric Health Information System database. Rurality was determined using ZIP codes and the Rural-Urban Community Areas classification system. Rural children made up 12% of total admissions and traveled a median of 68 miles to get to the hospital. Six percent of admissions were of children from an HPSA, and 52.8% of rural children lived in ZIP codes with incomes less than 150% of the Federal poverty line, compared to 24.4% of non-rural children (P < .001). Rural children had higher percentages of at least 1 chronic medical condition (71.4% vs 66.6%, P < .001) and required technology assistance (14.6% vs 11.7%, P < .001). Mean inpatient cost among rural patients was higher compared to non-rural patients ($8507 vs $7814, P < .001). These patients also experienced higher rates of 30-day readmission rates (12.9% vs 11.5%, P < .001).

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