Rural health disparities in asthma care and outcomes

摘要

Fifty-nine million Americans (21% of the US population) live in rural areas of the United States. Compared to persons living in urban areas of the US, rural populations have lower income, a higher rate of government versus private insurance, and decreased access to health care. While there are reports of lower asthma prevalence in rural areas, the majority of this data has been published on international populations, with little available data looking at American urban versus rural asthma prevalence on a national scale or comparing rural to nearby urban cohorts in the US. A large body of literature, mainly generated from studies of rural Europe, suggests that lower prevalence may be due to beneficial effects of exposure to farm environments, but the extent to which this applies to the rural US, where a smaller proportion of the population engages in farming, is unclear. The United States has the additional covariate of having a higher proportion of African-Americans, who have a greater asthma burden than whites independent of socioeconomic status, clustered in cities. There is data indicating that rural patients have increased difficulty obtaining healthcare in general, and limited data suggesting that they receive inferior care for asthma. Future work is needed to more clearly define asthma prevalence and morbidity among residents of the rural US, as well as to identify interventions effective in this population.