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The Effects of Geography and Spatial Behavior on Health Care Utilization among the Residents of a Rural Region
Open accessAbstract
Objective.This analysis determines the importance of geography and spatial behavior as predisposing and enabling factors in rural health care utilization, controlling for demographic, social, cultural, and health status factors. Data Sources.A survey of 1,059 adults in 12 rural Appalachian North Carolina counties. Study Design.This cross‐sectional study used a three‐stage sampling design stratified by county and ethnicity. Preliminary analysis of health services utilization compared weighted proportions of number of health care visits in the previous 12 months for regular check‐up care, chronic care, and acute care across geographic, sociodemographic, cultural, and health variables. Multivariable logistic models identified independent correlates of health services utilization. Data Collection Methods.Respondents answered standard survey questions. They located places in which they engaged health related and normal day‐to‐day activities; these data were entered into a geographic information system for analysis. Principal Findings.Several geographic and spatial behavior factors, including having a driver's license, use of provided rides, and distance for regular care, were significantly related to health care utilization for regular check‐up and chronic care in the bivariate analysis. In the multivariate model, having a driver's license and distance for regular care remained significant, as did several predisposing (age, gender, ethnicity), enabling (household income), and need (physical and mental health measures, number of conditions). Geographic measures, as predisposing and enabling factors, were related to regular check‐up and chronic care, but not to acute care visits. Conclusions.These results show the importance of geographic and spatial behavior factors in rural health care utilization. They also indicate continuing inequity in rural health care utilization that must be addressed in public policy.
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“and can be more accessible than multiweek interventions, particularly for individuals from rural communities [34].”
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Metadata
- Authors
- Arcury, T. A., Gesler, W. M., Preisser, J. S., Sherman, J., Spencer, J., & Perin, J.
- Affiliations
- Wake Forest University Health Sciences (US)
- University of North Carolina at Chapel Hill (US)
- Corresponding author
- Arcury, Thomas A.
- Venue
- Health Services Research
- Publisher
- Wiley
- Published
- 2005-01-21
- Volume
- 40
- Issue
- 1
- Pages
- 135-156
- ISSN
- 0017-9124 (ISSN-L)
- 1475-6773
- PMC
- PMC1361130
- OpenAlex
- W2127606804
- Cited by
- 594
- References
- 38
- Citations by year
- 2026: 15 · 2025: 26 · 2024: 23 · 2023: 30 · 2022: 23 · 2021: 36 · 2020: 35 · 2019: 31 · 2018: 41 · 2017: 34 · 2016: 39 · 2015: 45 · 2014: 39 · 2013: 29 · 2012: 35
- FWCI
- 15.22
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Health Services Research (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Agency for Healthcare Research and Quality (R01 HS009624, R01 HS09624)
- Topics
- Social Sciences › Health › Public Health and Social Inequalities
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Social Sciences › Health › Health disparities and outcomes
- Keywords
- spatial behavior, geographical factors, rural health disparities, driving licence, distance to care, chronic care, acute care, household income, physical and mental health, health care access
- MeSH terms
- Adult, Appalachian Region, Cross-Sectional Studies, Female, Geography, Health Services Accessibility, Health Status, Humans, Male, Models, Theoretical, North Carolina, Patient Acceptance of Health Care, Residence Characteristics, Spatial Behavior, Transportation, Health Behavior, Multivariate Analysis, Logistic Models, Rural Health Services
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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