Rural/Urban differences in health services deficits among U.S. adults with arthritis: A population- based study

Introduction: More than 21% of adults in the United States (U.S.) have self-reported physician diagnosed arthritis with the prevalence increasing to 70% for adults aged 75 years and older. Despite significant disease burden of arthritis, little research has been conducted to examine health service deficits experienced by U.S. adults with this disease. Since U.S. rural residents experience more disease and greater health and health care disparities than urban residents, this study sought to ascertain the prevalence of health service deficits in U.S. adults with arthritis and to explore whether rural residents experienced greater deficits than urban residents. Methods: Multivariate techniques were performed on 2011 Behavioral Risk Factor Surveillance System data to determine if there were differences in the prevalence of health service deficits in rural versus urban adults with arthritis and if rural residency was an independent risk factor for health service deficits after controlling for socioeconomic status and race/ ethnicity. The population of interest was U.S. adults who self-reported having arthritis diagnosed by a health care provider. Results: Bivariate analysis revealed and logistic regression confirmed that among U.S. adults > 45 years of age, rural residency was a predictor for a higher prevalence of arthritis as well as for health service deficits among those with arthritis. Overall about 1 in 3 individuals > 45 years of age suffering from arthritis experienced a health deficit.  The two most common health service deficits were not having a routine medical checkup within the last 12 months and deferring health care because of cost. Rural residency emerged as an independent risk factor for health service deficits after controlling for socioeconomic status and race/ethnicity. Conclusions: Many individuals with arthritis experience a health service deficit and rural residents are at greater risk when compared to their urban counterparts. Given the burden of disease from arthritis the results suggest that there is considerable potential for improving services and perhaps improving outcomes for individuals with arthritis. The finding that the most common health service deficits were delaying care because of cost and not having seen a provider within the last 12 months suggests that finances rather than simply the availability of services is a key factor.