In Rural Areas, Does Racial Segregation Contribute to Disparities in Health Care?

Does racial or ethnic residential segregation in rural areas contribute to unequal access to health care? Julia Caldwell and her colleagues examine this question in their article in Health & Place, expanding on previous literature that focuses on the link between social factors and health care in urban areas. The authors used data from the Medical Expenditure Panel Survey (MEPS) from 2005 through 2010, which collected self-reported information about access to health care; data from the American Community Survey between 2005 and 2009; and the 2010 Area Health Resources Files. Access to health care was measured using the variables, as indicated in responses on MEPS, usual source of health care, health care needs are met, cholesterol screening, and cervical screening; racial and ethnic segregation was measured using the isolation index separately for African Americans and Hispanics. After further restricting their sample to rural areas, areas not designated as a metropolitan statistical area, the authors performed statistical analysis on the four variables for access to health care to test three hypotheses related to health care access, segregation, and rural housing. They find that higher segregation rates were linked to lower access to a usual source of health care, but higher rates of self-reported health care needs being met among African Americans and Hispanics. The relationship between residential segregation and health care in rural areas is not well understood, and the authors call for more work to better understand these complex dynamics.

Key findings

• The percentage of African Americans and Hispanics who live in rural areas and have a usual source of health care was less than that of non-Hispanic whites.
• As segregation increased in rural areas, more African Americans and Hispanics reported their health care needs were met.
• In contrast to previous national studies, the association between segregation and access to a usual source of health care was not significant, after controlling for measures of poverty and health care supply.
• While the authors observed no significant link between segregation and health screenings in rural areas, rural adults had fewer screenings within recommended intervals than urban adults, a finding that supports previous literature on rural disadvantage for preventive health care.