Journal of Rural Health最新文献_第6页

Weaving the rural health safety net: Voices from the field 编织农村卫生安全网：来自田野的声音。

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-09-29 DOI: 10.1111/jrh.70080

Jessica Riley MS, Eileen M. Dryden PhD, Catherine M. P. Dawson MD, Meaghan A. Kennedy MD, MPH, Lauren R. Moo MD, Camilla B. Pimentel PhD, William Hung MD

引用次数: 0

The roles of COVID-19 pandemic exposure and telehealth in prenatal care access for rural and racial minority communities in the United States: A retrospective cohort study COVID-19大流行暴露和远程医疗在美国农村和少数族裔社区产前护理获取中的作用：一项回顾性队列研究

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-09-29 DOI: 10.1111/jrh.70077

Peiyin Hung PhD, Jiani Yu PhD, Adiba B. Promiti MS, Berry A. Campbell MD, MFM, Nansi S. Boghossian PhD, Anirban Chatterjee MD, Bo Cai PhD, Jihong Liu ScD, the National COVID Cohort Collaborative Consortium

Purpose

To examine how COVID-19 public health emergency (PHE) exposure during pregnancy and telehealth use were associated with rural-urban and racial/ethnic differences in prenatal care initiation timing and frequency.

Methods

This retrospective cohort study of 349,682 pregnancies to birthing individuals who received both prenatal and intrapartum care at the 75 health systems in the United States contributing to the National Clinical Cohort Collaborative (N3C) from 6/1/2018 through 5/31/2022. Outcomes included prenatal care initiation timing and the number of prenatal care visits. Prenatal periods were categorized into 3 PHE exposure groups: (1) never, (2) partially, and (3) fully exposed to the PHE. The full-exposure group was further categorized into telehealth users and those with exclusively in-person care.

Findings

The full-exposure group with telehealth uptake had the earliest prenatal care initiation (median: 9 weeks [interquartile range: 7-13]) and the most visits (19 visits [12-20]). In contrast, the full-exposure group without telehealth use initiated care the latest (11 weeks [8-21]) and had the fewest visits (13 visits [6-22]). Rural-urban disparities persisted; however, telehealth users in both groups had earlier initiation and more visits. Racial and ethnic disparities in timeliness to initiation were most pronounced among the full-exposure group with telehealth (Black-White: adjusted hazard ratio [aHR]: 0.76, 95% CI, 0.70-0.83; Hispanic-White: aHR: 0.62, 95% CI, 0.58-0.68), compared to the full-exposure group with exclusively in-person care (Black-White: 0.95 [0.93-0.94]; Hispanic-White: 0.80 [0.80-0.81]).

Conclusions

Prenatal telehealth care improved early initiation but also exacerbated racial/ethnic disparities in the timeliness of prenatal care access. However, rural-urban disparities persisted.

目的：探讨妊娠期COVID-19突发公共卫生事件（PHE）暴露和远程医疗使用与城乡和种族/民族产前护理开始时间和频率差异的关系。方法：从2018年6月1日至2022年5月31日，这项回顾性队列研究纳入了349,682名怀孕至分娩的个体，这些个体在美国75个卫生系统接受了产前和产时护理，这些卫生系统为国家临床队列协作（N3C）做出了贡献。结果包括产前护理开始时间和产前护理访问次数。产前期被分为三个PHE暴露组：(1)从不暴露，(2)部分暴露，(3)完全暴露于PHE。全面接触组进一步分为远程保健用户和仅接受面对面护理的用户。结果：远程医疗全暴露组产前护理开始时间最早（中位数：9周[四分位数间距：7-13]），就诊次数最多（19次[12-20]）。相比之下，未使用远程医疗的全暴露组开始护理时间最晚（11周[8-21]），就诊次数最少（13次[6-22]）。城乡差距依然存在；然而，两组的远程医疗用户都有较早的开始和更多的访问。与完全面对面护理的完全接触组（黑人-白人：调整风险比[aHR]: 0.76, 95% CI, 0.70-0.83；西班牙裔-白人：aHR: 0.62, 95% CI, 0.58-0.68）相比，远程医疗的全面接触组（黑人-白人：0.95[0.93-0.94]；西班牙裔-白人：0.80[0.80-0.81]），在开始治疗的及时性方面的种族和民族差异最为明显。结论：产前远程保健改善了早期启动，但也加剧了产前护理获得及时性的种族/民族差异。然而，城乡差距依然存在。

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引用次数: 0

Differences in the travel burden for care between rural and urban patients with opioid use disorder by insurance type 农村和城市阿片类药物使用障碍患者按保险类型的医疗差旅负担差异

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-09-29 DOI: 10.1111/jrh.70078

C. Holly A. Andrilla MS, Sara C. Woolcock MPH, Lisa A. Garberson PhD, Janessa M. Graves PhD

Purpose

To compare the time and distance travel burden to access care for rural and urban Medicaid and commercially insured patients with opioid use disorder (OUD), and to understand where they travel for care.

Methods

We used Medicaid and the Health Care Cost Institute commercial insurance administrative claims data from 2019 to examine the travel burden to health care for adults ages 18 years and older with OUD. We calculated the one-way driving distance and travel time between the enrollee's residence and the provider's location. We used the 2013 Urban Influence Codes (UIC) to classify enrollees as either urban (UIC 1–2) or rural (UIC 3–12) based on the patient's residence county.

Findings

The median distance traveled for a visit by a rural Medicaid or rural commercially insured enrollee was more than twice as far as their urban counterparts (rural Medicaid: 45.9 miles, urban Medicaid: 13.9 miles; rural commercially insured: 32.9 miles, urban commercially insured: 12.4 miles). When we imputed zeros for care provided in the same ZIP Code as an enrollee's residence, these differences persisted. Rural Medicaid enrollees carried the largest travel burden spending an average of more than 60 min traveling to care, about 30 min more than rural commercially insured enrollees. Urban enrollees, regardless of insurance type received almost all of their care in an urban location while rural Medicaid and commercially insured patients traveled to an urban location for about half their visits.

Conclusions

Rural and urban Medicaid and commercially insured enrollees experience different time and distance travel burdens.

目的：比较农村和城市医疗补助和商业保险的阿片类药物使用障碍（OUD）患者获得护理的时间和距离负担，并了解他们前往何处接受护理。方法：我们使用医疗补助计划和医疗保健成本研究所2019年的商业保险行政索赔数据，研究18岁及以上OUD患者的医疗保健旅行负担。我们计算了投保人住所和医疗机构所在地之间的单程驾驶距离和旅行时间。我们使用2013年城市影响代码（UIC）根据患者居住的县将参选者分为城市（UIC 1-2）或农村（UIC 3-12）。研究结果：农村医疗补助计划或农村商业保险参保者就诊的中位数距离是城市参保者的两倍多（农村医疗补助计划：45.9英里，城市医疗补助计划：13.9英里；农村商业保险：32.9英里，城市商业保险：12.4英里）。当我们对与参保人居住地相同的邮政编码提供的医疗服务进行零输入时，这些差异仍然存在。农村医疗补助计划的参保者承担的旅行负担最大，平均花费超过60分钟，比农村商业参保的参保者多30分钟。无论保险类型如何，城市参保者几乎在城市地区接受了所有的医疗服务，而农村医疗补助计划和商业参保的患者大约有一半的就诊时间前往城市地区。结论：城乡医疗补助和商业参保参保人的时间和距离负担不同。

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引用次数: 0

Adverse childhood experiences and preventive health care among rural US children: A cross-sectional examination of 2022 National Health Interview Survey data 美国农村儿童的不良童年经历和预防性保健：对2022年全国健康访谈调查数据的横断面检查

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-09-28 DOI: 10.1111/jrh.70081

Mary Labuhn MPH, Andrew Williams MPH, PhD

Purpose

Rural-residing children have poor access to preventive health care due to geographic and socioeconomic issues, yet the role of adverse childhood experiences (ACEs) in preventive care for rural children has been understudied. It is hypothesized that among rural-residing children, those with ≥1 ACE will have lower utilization of preventive health care, with differences by sex.

Methods

Data for 425 (weighted n = 3,949,102) children (aged 9-17) residing in “nonmetropolitan” (2013 NCHS Urban-Rural Classification) were drawn from the 2022 National Health Interview Survey. Physician visit in the past 12 months (yes/no), dental visit in the past 12 months (yes/no), COVID-19, flu, and HPV vaccination (yes/no) were self-reported. Participants self-reported (yes/no) to 6 ACEs (high ACEs ≥1). Logistic regression estimated odds ratios and 95% confidence intervals for associations between ACEs and preventive health outcomes, adjusted for demographic and health care factors. This manuscript adheres to STROBE guidelines.

Findings

Children with ≥1 ACE were 81% more likely (OR = 1.81, 95% CI 1.04, 3.18) to receive a flu vaccination and 184% (OR = 2.84, 95% CI 1.66, 4.85) more likely to receive an HPV vaccination compared to children with 0 ACEs. No significant associations were found between ACEs and other preventive health care. Boys with ≥1 ACE had decreased odds (OR = 0.34, 95% CI 0.13, 0.94) of visiting a dentist, while girls with ≥1 ACE had increased odds (OR = 3.87, 95% CI 1.56, 9.60) of receiving an HPV vaccination.

Conclusions

Children with ≥1 ACE were more likely to receive a flu vaccination and HPV vaccination. The effect of ACEs on preventive health care may differ by sex among rural residents, yet additional research is warranted to inform prevention efforts in rural communities.

目的由于地理和社会经济问题，农村儿童难以获得预防性保健，但不良童年经历（ace）在农村儿童预防性保健中的作用尚未得到充分研究。假设在农村儿童中，ACE≥1的儿童对预防性保健的利用率较低，且存在性别差异。方法从2022年全国健康访谈调查中抽取425名（加权n = 3,949,102）名居住在“非大都市”（2013年NCHS城乡分类）的儿童（9-17岁）的数据。自我报告过去12个月的医生就诊（是/否）、过去12个月的牙科就诊（是/否）、COVID-19、流感和HPV疫苗接种（是/否）。参与者自我报告（是/否）至6个ace（高ace≥1）。经人口统计学和卫生保健因素调整后，Logistic回归估计了ace与预防性健康结果之间的比值比和95%置信区间。本手稿遵循STROBE指南。与无ACE的儿童相比，ACE≥1的儿童接受流感疫苗接种的可能性增加81% (OR = 1.81, 95% CI 1.04, 3.18)， HPV疫苗接种的可能性增加184% （OR = 2.84, 95% CI 1.66, 4.85）。ace与其他预防性保健之间未发现显著关联。ACE≥1的男孩看牙医的几率降低（OR = 0.34, 95% CI 0.13, 0.94），而ACE≥1的女孩接受HPV疫苗接种的几率增加（OR = 3.87, 95% CI 1.56, 9.60）。结论：ACE≥1的儿童更有可能接种流感疫苗和HPV疫苗。在农村居民中，ace对预防保健的影响可能因性别而异，但需要进一步的研究来为农村社区的预防工作提供信息。

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引用次数: 0

Skill mix versus flexibility: Decoding nurse staffing impacts on critical access hospitals 技能组合与灵活性：解码护士人员配置对关键医院的影响

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-08-28 DOI: 10.1111/jrh.70075

Dinesh R. Pai PhD, Esmaeil Bahalkeh PhD

Objective

This study examines the effect of nurse staffing (skill mix and flexibility) on the financial sustainability, efficiency, and quality of care in Pennsylvania's critical access hospitals (CAHs) from 2000 to 2023.

Methods

This retrospective longitudinal study utilized unbalanced panel data from Pennsylvania's CAHs (n = 357 hospital-year observations). We employed 2-way fixed effects regression models to analyze the relationship between nurse staffing variables (skill mix and flexibility) and hospital performance outcomes (total margin, cost per adjusted discharge [CPAD], cost per adjusted patient day [CPPD], average length of stay [ALOS], and readmission index). We controlled for hospital-specific, socioeconomic, and demographic factors.

Results

A higher registered nurse (RN) skill mix significantly reduced log(winsorized(CPAD)) (β = −0.495, p<0.01) and log(ALOS) (β = −0.571, p<0.01), indicating improved cost efficiency and patient throughput. Increased nurse flexibility significantly increased log(ALOS) (β = 0.315, p<0.05) but reduced the readmission index (β = −0.895, p<0.01). No significant associations were found between skill mix and total margin, CPPD, or readmission index, nor between flexibility and financial metrics.

Discussion

A richer RN skill mix enhances efficiency by reducing costs and length of stay, while increased staffing flexibility reduces readmissions but extends ALOS. These findings emphasize the complex interplay between nurse staffing and CAH performance. Strategic management of RN skill mix and flexibility is crucial for optimizing resource use and improving patient outcomes in rural hospitals.

Conclusions

Policymakers and CAH administrators should strategically balance RN expertise and staffing flexibility to ensure both financial viability and clinical excellence in these essential rural health care institutions.

目的：本研究探讨2000年至2023年宾夕法尼亚州关键医院（CAHs）护士人员配置（技能组合和灵活性）对财务可持续性、效率和护理质量的影响。方法本回顾性纵向研究利用来自宾夕法尼亚州CAHs的非平衡面板数据（n = 357个医院年观察）。我们采用双向固定效应回归模型分析护士人员配置变量（技能组合和灵活性）与医院绩效结果（总利润、每次调整出院成本（CPAD）、每次调整病人日成本（CPPD）、平均住院时间（ALOS）和再入院指数）之间的关系。我们控制了医院特定因素、社会经济因素和人口因素。结果较高的注册护士（RN）技能组合显著降低了log(winsorized， CPAD) （β = - 0.495, p<0.01）和log(ALOS) (β = - 0.571, p<0.01)，提高了成本效率和患者吞吐量。增加护士灵活性可显著提高log(ALOS) (β = 0.315, p<0.05)，降低再入院指数（β = - 0.895, p<0.01）。没有发现技能组合与总边际、CPPD或再入院指数之间的显著关联，也没有发现灵活性和财务指标之间的显著关联。更丰富的注册护士技能组合通过减少成本和住院时间来提高效率，而增加的人员灵活性减少了再入院，但延长了ALOS。这些发现强调了护士人员配置与CAH绩效之间复杂的相互作用。战略管理护士的技能组合和灵活性是优化资源利用和改善农村医院病人的结果至关重要。结论决策者和CAH管理者应在战略上平衡注册护士专业知识和人员配置灵活性，以确保这些基本农村卫生保健机构的财务可行性和临床卓越性。

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引用次数: 0

Rural and urban differences in treatment on demand for substance use treatment involving medications for opioid use disorder 城乡在涉及阿片类药物使用障碍药物的物质使用治疗需求方面的差异

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-08-25 DOI: 10.1111/jrh.70076

Ryan J. Lofaro PhD, Robert M. Bohler PhD, Robert Spurgeon BA, William A. Mase DrPH

Purpose

Research has found that the use of medications for opioid use disorder (MOUD) varies across the rural-urban divide; however, relationships between rurality, MOUD, and substance use treatment wait times remain underexplored. This study analyzes associations between rurality, MOUD usage, and immediate access to outpatient treatment—that is, “treatment on demand”—in the United States.

Methods

Using 2021-2022 Treatment Episode Data Set Admissions (TEDS-A) data on outpatient treatment centers, we employ logistic regression to analyze treatment on demand (0-day wait time) as the outcome and rurality as the key predictor in models disaggregated into patients who utilized MOUD at intake and those who did not. Analyses are also disaggregated by Census region and division of the country.

Findings

Results show that rurality reduces the odds of treatment on demand in both MOUD (OR = .513, P <.001) and non-MOUD (OR = .593, P <.001) models, with slightly stronger effects in the former. Associations with rurality vary substantially by region of the country. MOUD models in the Midwest, West, and South show rurality has a significant negative effect; these negative associations held for non-MOUD models only in the South. Further, differences across Census divisions highlight rurality's spatial disparities at a more granular level.

Conclusions

Understanding barriers to treatment on demand for evidence-based treatments is a crucial aspect of ensuring people who have opioid use disorder in rural regions receive the care they need. Policies should focus on increasing access to treatment to avoid delays while considering regional differences.

研究发现，阿片类药物使用障碍（mod）的药物使用在农村和城市之间存在差异；然而，农村、mod和药物使用治疗等待时间之间的关系仍未得到充分探讨。本研究分析了在美国农村地区、mod使用情况和立即获得门诊治疗（即“按需治疗”）之间的关系。方法使用门诊治疗中心的2021-2022年治疗事件数据集入院（TEDS-A）数据，我们采用logistic回归分析按需治疗（0天等待时间）作为结果，农村性作为模型的关键预测因素，并将模型分解为在入院时使用mod和未使用mod的患者。分析还按人口普查地区和国家划分进行了分类。结果显示，乡村性降低了mode （OR = .513, P <.001）和非mode （OR = .593, P <.001）模型中按需治疗的几率，前者的影响略强。与乡村性的联系在全国各地差别很大。中西部、西部和南部的模型显示乡村性具有显著的负向影响；这些负面关联仅在南方的非mod模式中成立。此外，人口普查部门之间的差异在更细粒度的层面上突出了农村的空间差异。了解循证治疗需求治疗的障碍是确保农村地区阿片类药物使用障碍患者获得所需护理的一个关键方面。政策应侧重于增加获得治疗的机会，以避免延误，同时考虑到区域差异。

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引用次数: 0

Trends in mental health care utilization in rural and nonrural areas, 2019-2023 2019-2023年农村和非农村地区精神卫生保健利用趋势

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-08-23 DOI: 10.1111/jrh.70074

Bryce J. Stanley PhD

Purpose

The recent increase in mental health care providers offering telehealth may improve access by reducing travel costs, particularly for those in rural areas. This paper seeks to understand how mental health care utilization changed from 2019 to 2023 for rural and nonrural areas.

Methods

This study uses data from the National Health Interview Survey for 2019 and 2021-2023 (n = 118,652). To adjust the utilization rates for sociodemographic factors, a probit model with survey weights is used. For each year, the adjusted percentage of rural and nonrural populations receiving any mental health care in the past year is reported. Changes in demographic characteristics of those receiving care are also discussed.

Findings

This study finds that both rural and nonrural populations experienced large increases in adjusted mental health care utilization rates from 2019 to 2023. Utilization rates in rural areas grew 3.72 percentage points, from 9.35% (95% CI: 8.85-9.84) in 2019 to 13.07% (95% CI: 12.86-13.28) in 2023. For nonrural areas, utilization rates increased 4.40 percentage points, from 12.06% (95% CI: 11.79-12.74) in 2019 to 16.46% (95% CI: 15.82-17.11) in 2023.

Conclusion

Rural populations utilize less mental health care than nonrural populations, but both saw a substantial increase from 2019 to 2023. While telehealth may particularly benefit rural areas, these data suggest a larger increase in utilization for nonrural respondents. Future work is needed to better understand remote mental health care and rural populations.

目的最近提供远程医疗服务的精神卫生保健提供者的增加可以通过降低旅行费用，特别是农村地区的旅行费用，改善获得远程医疗服务的机会。本文旨在了解2019 - 2023年农村和非农村地区精神卫生保健利用的变化情况。方法本研究使用2019年和2021-2023年全国健康访谈调查数据（n = 118,652）。为了调整社会人口因素的利用率，使用了带有调查权重的概率模型。每年报告过去一年接受任何精神保健的农村和非农村人口的调整后百分比。还讨论了接受护理者人口统计学特征的变化。本研究发现，2019年至2023年，农村和非农村人口的调整后精神卫生保健使用率均大幅上升。农村地区的利用率增长了3.72个百分点，从2019年的9.35% （95% CI: 8.85-9.84）增长到2023年的13.07% （95% CI: 12.86-13.28）。在非农村地区，利用率提高了4.40个百分点，从2019年的12.06% （95% CI: 11.79-12.74）提高到2023年的16.46% （95% CI: 15.82-17.11）。结论农村人口的精神卫生保健使用率低于非农村人口，但从2019年到2023年，农村人口和非农村人口的精神卫生保健使用率均大幅上升。虽然远程保健可能特别有利于农村地区，但这些数据表明，非农村应答者利用远程保健的比例有较大提高。未来的工作需要更好地了解偏远地区的精神卫生保健和农村人口。

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引用次数: 0

Rural patients’ experiences with diagnosis and treatment of endometrial cancer 农村子宫内膜癌诊治体会

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-08-22 DOI: 10.1111/jrh.70065

Victoria M. Petermann PhD, RN, Brianna D. Taffe MPH, Blen M. Biru MSc, Jennifer Leeman DrPH, MPH, MDiV, Ashley Leak Bryant PhD, RN, OCN, FAAN, Benjamin B. Albright MD, MS, Stephanie B. Wheeler PhD, MPH, Victoria L. Bae-Jump MD, PhD, Lanneau Grainger MD, Lisa P. Spees PhD

Background

Rural endometrial cancer (EC) patients are less likely to receive lymph node evaluation, high-quality surgical care, and adjuvant therapy compared to urban patients. Developing interventions to effectively address barriers to quality care requires understanding patient experiences across the cancer care continuum. Our objective was to understand the diagnostic and treatment experiences of rural EC patients.

Methods

We conducted semistructured interviews with 23 participants (22 patients, one caregiver) from rural counties in North Carolina. We developed a semistructured interview guide to examine the experiences of patients during diagnosis and treatment. Initial codes were derived from a multilevel conceptual framework of rural cancer control, and transcribed interviews were analyzed using thematic analysis.

Results

We identified six themes reflecting determinants of diagnosis and seven themes for treatment of EC for rural patients. Provider knowledge of EC symptoms, patient symptom normalization, and fear were all discussed as major factors impacting delays in EC diagnosis. Participants noted that social networks influenced them to seek care for symptoms they did not otherwise see as concerning. During treatment, participants experienced financial burdens, and many reported significant challenges traveling to treatment. Social networks were critical for financial support and transportation to and from treatment. Personal health care experiences and community perceptions about rural cancer care also influenced decisions about where to seek gynecologic cancer treatment.

Conclusions

This study highlights the need to improve rural provider adherence to guidelines for EC detection, increase symptom knowledge among rural communities, and implement comprehensive assessments of unmet needs of rural patients during treatment.

背景：与城市患者相比，农村子宫内膜癌（EC）患者接受淋巴结评估、高质量手术护理和辅助治疗的可能性较小。开发干预措施以有效地解决高质量护理的障碍，需要了解整个癌症护理连续体的患者经历。我们的目的是了解农村EC患者的诊断和治疗经验。方法：我们对来自北卡罗来纳州农村县的23名参与者（22名患者，1名护理人员）进行了半结构化访谈。我们开发了一种半结构化的访谈指南来检查患者在诊断和治疗期间的经历。从农村癌症控制的多层次概念框架中获得初始代码，并使用主题分析对转录的访谈进行分析。结果我们确定了反映诊断决定因素的6个主题和农村患者EC治疗的7个主题。提供者对EC症状的了解、患者症状的正常化和恐惧都被认为是影响EC诊断延误的主要因素。参与者指出，社交网络影响了他们去寻求治疗，否则他们就不会关注这些症状。在治疗期间，参与者经历了经济负担，许多人报告了前往治疗的重大挑战。社交网络对经济支持和往返治疗的交通至关重要。个人保健经历和社区对农村癌症护理的看法也影响到在哪里寻求妇科癌症治疗的决定。结论：本研究强调需要提高农村医疗服务提供者对EC检测指南的依从性，增加农村社区的症状知识，并对农村患者在治疗过程中未满足的需求进行全面评估。

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引用次数: 0

Hearing aid acquisition patterns among US Veterans who use VA health care 使用VA医疗保健的美国退伍军人的助听器获取模式

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-08-17 DOI: 10.1111/jrh.70068

Laura Coco PhD, AuD, Loretta Shields PhD, Rachel Phillips MS, Stephanie Pesa AuD, Matthew Hamilton-Sutherland AuD, Kathleen F. Carlson PhD, MS, Dawn L. Konrad-Martin PhD, Kelly M. Reavis PhD, MS, MPH

Purpose

The primary objective of this observational study was to describe the population of Veterans who did and did not receive a hearing aid following an incident hearing loss diagnosis during the 12-year study period. We also sought to measure the relationship between hearing loss severity and hearing aid acquisition and explore how this association differs according to Veterans’ urban/rural residential status. Understanding associations of clinical or demographic characteristics with hearing aid acquisition by US Veteran health care users may contribute to more effective treatment of hearing loss.

Method

We examined all Veteran electronic health records to identify participants with an incident (new) hearing loss diagnosis between January 2011 and June 2023. Hearing loss was identified using International Classification of Diseases diagnosis codes and audiogram results. Hearing aid fittings were identified using Current Procedural Terminology codes. Poisson regression models were used to compute rate ratios and 95% confidence intervals of hearing aid acquisition.

Results

Among 256,409 Veterans with an incident hearing loss diagnosis, the prevalence of hearing aid acquisition was 81% (n = 206,438) during the study period. Among Veterans who received hearing aids, a greater proportion were older, male, White, non-Hispanic, married, and from higher income groups. The average number of days between hearing loss diagnosis and hearing aid fitting was less than 1 year (M = 200 days; SD = 502 days). The association between hearing loss severity and hearing aid acquisition was stronger among urban Veterans compared to rural Veterans, and there was a significant interaction between hearing loss severity and urban/rural status (p < .0001).

Conclusions

This large, national cohort study provides the first description of hearing aid acquisition patterns among Veterans using VA health care. Hearing aid uptake was high overall but varied by demographic and geographic factors. The observed differences may reflect structural challenges or variations in perceived need. These findings can help inform targeted VA programs aimed at improving timely uptake of hearing care, particularly among rural Veteran populations.

本观察性研究的主要目的是描述在12年的研究期间，在意外听力损失诊断后接受和未接受助听器的退伍军人人群。我们还试图衡量听力损失严重程度与助听器购置之间的关系，并探讨这种关系如何根据退伍军人的城市/农村居住状况而有所不同。了解临床或人口统计学特征与美国退伍军人医疗保健用户获得助听器的关联可能有助于更有效地治疗听力损失。方法：我们检查了所有退伍军人的电子健康记录，以确定2011年1月至2023年6月期间诊断为偶发性（新）听力损失的参与者。使用国际疾病分类诊断代码和听力图结果确定听力损失。助听器配件使用现行程序术语代码进行识别。使用泊松回归模型计算获得助听器的比率和95%置信区间。结果在256409名诊断为偶发性听力损失的退伍军人中，研究期间佩戴助听器的比例为81% （n = 206438）。在接受助听器的退伍军人中，较大比例的人是老年人、男性、白人、非西班牙裔、已婚和高收入群体。从听力损失诊断到助听器配戴的平均时间小于1年(M = 200天；SD = 502天)。与农村退伍军人相比，城市退伍军人的听力损失严重程度与助听器获得之间的相关性更强，并且听力损失严重程度与城乡状况之间存在显著的相互作用(p <；。)。这项大型的全国性队列研究首次描述了使用VA医疗保健的退伍军人获得助听器的模式。助听器使用率总体较高，但因人口和地理因素而异。观察到的差异可能反映了结构性挑战或感知需求的变化。这些发现可以帮助有针对性的VA项目，旨在提高听力保健的及时吸收，特别是在农村退伍军人群体中。

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引用次数: 0

Tobacco retailer density and rurality across four US states: California, Connecticut, North Carolina, and Ohio 美国四个州的烟草零售商密度和乡村性：加利福尼亚州，康涅狄格州，北卡罗来纳州和俄亥俄州

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health

Pub Date : 2025-08-15 DOI: 10.1111/jrh.70073

Emerson Webb MS, Peter F. Craigmile PhD, Meghan E. Morean PhD, Grace Kong PhD, Joseph G. L. Lee PhD, Ryan J. Martin PhD, Jessica Barrington-Trimis PhD, Rui Qiang PhD, Vitoria Borges Spinola DDS, Megan E. Roberts PhD

Purpose

Research has demonstrated many types of disparities in tobacco retailer density (TRD), but these analyses often fail to explore rural disparities. Given the substantial burden of rural tobacco use in the USA, this is a critical gap. The purpose of the present study was to estimate rural disparities in TRD across four US states.

Methods

For the states of California, Connecticut, North Carolina, and Ohio, we used spatial statistical methods to model per capita TRD at the census tract level. Rurality was defined by the US Department of Agriculture Rural-Uran Commuting Area (RUCA) codes and categorized into Metropolitan, Micropolitan, Small Town, and Rural.

Findings

Tobacco retailer count was highest in California (22,533), but TRD was highest in Connecticut (1.23 retailers per 1000 residents). In models for California, North Carolina, and Ohio (but not Connecticut), there was an association between rurality and TRD, such that rural census tracts had greater TRD than metropolitan census tracts. Micropolitan and small town (vs. metropolitan) census tracts also had greater TRD, although the association was not as strong. Models further showed associations between TRD and census tract poverty, racial and ethnic composition, and Appalachian designation.

Conclusions

Although there are notable state-level differences, TRD is clearly associated with rurality. Given the literature on the impacts of living in tobacco-retailer-dense areas, rural disparities in TRD likely contribute to rural disparities in tobacco use. There is a need for further policies in rural areas of the USA that address the tobacco retailer environment.

研究表明烟草零售商密度（TRD）存在多种类型的差异，但这些分析往往未能探索农村的差异。鉴于美国农村烟草使用的巨大负担，这是一个重大差距。本研究的目的是估计美国四个州农村地区的TRD差异。方法针对加利福尼亚州、康涅狄格州、北卡罗来纳州和俄亥俄州，采用空间统计方法对人口普查区水平的人均TRD进行建模。农村是由美国农业部农村-城市通勤区（RUCA）代码定义的，分为大都市、小城市、小城镇和农村。烟草零售商数量在加利福尼亚州最高（22,533），但TRD在康涅狄格州最高（每1000名居民1.23家零售商）。在加利福尼亚州、北卡罗来纳州和俄亥俄州（但不包括康涅狄格州）的模型中，乡村性和TRD之间存在关联，因此农村人口普查区的TRD高于大都市人口普查区。小城市和小城镇（与大都市相比）人口普查区也有更高的TRD，尽管这种关联没有那么强。模型进一步显示了TRD与人口普查区贫困、种族和民族构成以及阿巴拉契亚地区之间的联系。结论虽然存在显著的州际差异，但TRD与乡村性明显相关。鉴于有关生活在烟草零售商密集地区的影响的文献，农村地区在TRD方面的差异可能导致农村地区在烟草使用方面的差异。美国农村地区需要进一步的政策来解决烟草零售商的环境问题。

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引用次数: 0