Cited by 594Public Health and Social InequalitiesHealthcare Policy and ManagementHealth disparities and outcomes

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The Effects of Geography and Spatial Behavior on Health Care Utilization among the Residents of a Rural Region

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Arcury, Thomas A., Gesler, Wilbert M., Preisser, John S., Sherman, Jill, Spencer, John, Perin, Jamie·2005·Health Services Research

DOI 10.1111/j.1475-6773.2005.00346.xPMC PMC1361130

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Abstract

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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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.
ORCID: Arcury, Thomas A.
Preisser, John S.
Sherman, Jill
Perin, Jamie
Venue: Health Services Research
Publisher: Wiley
Published: 2005-01-21
Volume: 40
Issue: 1
Pages: 135-156
ISSN: 0017-9124 (ISSN-L)
1475-6773
DOI: 10.1111/j.1475-6773.2005.00346.x
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
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
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

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The Effects of Geography and Spatial Behavior on Health Care Utilization among the Residents of a Rural Region

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