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Health Place. 2009 Sep;15(3):731-40. doi: 10.1016/j.healthplace.2008.12.007. Epub 2009 Jan 10.

Health care access in rural areas: evidence that hospitalization for ambulatory care-sensitive conditions in the United States may increase with the level of rurality.

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Department of Public Health Sciences, University of North Carolina, Charlotte, NC 28223, USA.


We examined whether levels of rurality are associated with hospitalization for ambulatory care-sensitive conditions (ACSH) in eight states of the United States. ACSH is an indicator of access to reasonably effective primary health care. ACSH for children did not vary systematically with rurality. Compared to the most urban counties, the adjusted rate in the most rural was 90% greater for ages 18-64 and 45% greater for ages 65+ (both p<.001). Adjusted adult rates generally increased with the level of rurality.


Increasing levels of rurality may be positively associated with ACSH, suggesting rural disparities in access to primary health care.

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