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Urban–Rural Differences in Health Care Utilization for Inflammatory Bowel Disease in the USA, 2017
Open accessAbstract
Background Urban-rural differences in IBD-specific health care utilization at the national level have not been examined in the USA. Aims We compared urban and rural rates of IBD-related office visits and IBD-specific (Crohn's disease (CD) or ulcerative colitis (UC)) hospitalizations and emergency department (ED) visits. Methods From multiple national data sources, we compared national rates using Z test and compared estimates of patient and hospital characteristics and hospitalization outcomes between urban and rural areas using Chi-square and t tests. Results In 2015 and 2016, digestive disease-related office visit rates, per 100 adults, were 3.1 times higher in urban than in rural areas (8.7 vs 2.8, P < 0.001). In 2017, age-adjusted rates per 100,000 adults were significantly higher in rural than urban areas for CD-specific hospitalizations (26.3 vs 23.6, P = 0.03) and ED visits (49.3 vs 39.5, P = 0.002). Compared with their urban counterparts, rural adults hospitalized for CD or UC in 2017 were more likely to be older and non-Hispanic white, have lower household income, Medicare coverage, and an elective admission, and were discharged from hospitals that were large, non-federal government owned, and in the Midwest or South. There were no significant urban-rural differences in length of stay and 30-day readmission rate. Conclusions While IBD or digestive disease-related office visit rates were lower in rural compared to urban areas, CD-specific hospitalization and ED visit rates were higher. Strategies that improve office-based care among rural patients with IBD may help to avoid more costly forms of health care use.
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The disparity between urban and rural populations, with rural areas such as micropolitan and non-Core (non-metro) regions exhibiting the highest AAMRs and Large Central Metro and Large Fringe Metro showing the lowest AAMRs, can be explained by disparity in healthcare utilization, shortage of gastroenterologists in rural compared to urban areas, inadequacy of insurance coverage, and longer travel距离
“A striking disparity was observed between urban and rural populations, with rural areas such as micropolitan and non‐Core (non‐metro) regions exhibiting the highest AAMRs and Large Central Metro and Large Fringe Metro showing the lowest AAMRs. This can be explained by the disparity in healthcare utilization between urban and rural status, the shortage of gastroenterologists in rural compared to ur”
From Trends and Demographics of Vascular Intestinal Diseases‐Related Mortality Among Adults Living in United States From 1999 to 2020; A CDC Wonder Analysis (2025) · cites this paper as [21]
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Metadata
- Authors
- Xu, F., Carlson, S. A., Liu, Y., & Greenlund, K. J.
- Affiliations
- Centers for Disease Control and Prevention (US)
- Corresponding author
- Xu, Fang
- Venue
- Digestive Diseases and Sciences
- Published
- 2021-10-11
- Volume
- 67
- Issue
- 8
- Pages
- 3601-3611
- ISSN
- 0163-2116 (ISSN-L)
- 1573-2568
- PMC
- PMC10478171
- OpenAlex
- W3206447445
- Cited by
- 24
- References
- 30
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 2 · 2023: 10 · 2022: 2 · 2021: 1
- FWCI
- 2.12
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Digestive Diseases and Sciences (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (CC999999)
- Centers for Disease Control and Prevention
- Topics
- Health Sciences › Medicine › Gastroenterology › Inflammatory Bowel Disease
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Social Sciences › Health › Health disparities and outcomes
- Keywords
- inflammatory bowel disease, Crohn's disease, ulcerative colitis, urban-rural disparities, health care utilization, hospitalization, emergency department visits, office visits, rural healthcare access, socioeconomic factors, Medicare coverage, hospital characteristics
- MeSH terms
- Adult, Aged, Chronic Disease, Colitis, Ulcerative, Crohn Disease, Medicare, Hospitalization, Humans, Patient Acceptance of Health Care, United States, Inflammatory Bowel Diseases
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