Contribution of Social Determinant of Health Factors to Rural-Urban Preventive Care Differences among Medicaid enrollees

Abstract Objective 1) Assess whether rural-urban disparities are present in pediatric preventive healthcare utilization; and 2) use regression decomposition to measure the contribution of social determinants of health (SDH) to those disparities. Methods With an Ohio Medicaid population served by a pediatric Accountable Care Organization, Partners For Kids, between 2017 and 2019, we used regression decomposition (a non-linear multivariate regression decomposition model) to analyze the contribution of patient, provider, and SDH factors to the rural-urban well child visit gap among children in Ohio. Results Among the 453,519 eligible Medicaid enrollees, 61.2% of urban children received a well child visit. Well child visit receipt among children from large rural cities/towns and small/isolated towns was 58.2% and 55.5%, respectively. Comparing large rural towns to urban centers, 55.8% of the 3.0 percentage-point difference was explained by patient, provider, and community-level SDH factors. In comparing small/isolated town to urban centers, 89.8% of the 5.7 percentage-point difference was explained by these characteristics. Of provider characteristics, pediatrician providers were associated with increased well visit receipt. Of the SDH factors, unemployment and education contributed the most to the explained difference in large rural towns while unemployment, education, and food deserts contributed significantly to the small/isolated town difference. Conclusions The receipt of pediatric preventive care is slightly lower in rural communities. While modest, the largest part of the rural-urban preventive care gap can be explained by differences in provider type, poverty, unemployment, and education levels. More could be done to improve pediatric preventive care in all communities.