Urban-rural Differences in Dental Care Use Among Adults Aged 18−64

July 7, 2021

DB412_Cover1Questions for Amy Cha, Health Statistician and Lead Author of “Urban-rural Differences in Dental Care Use Among Adults Aged 18−64.”

Q: How does the data vary by sex, race, and income level?

AC: In both urban and rural areas, the percentage of adults aged 18-64 who had a dental visit in the past 12 months was higher among women and non-Hispanic white adults than men and Hispanic adults. Also, the percentage of adults who had a dental visit increased as family income increased in both urban and rural areas.


Q: Why did you decide to look at dental visits by urbanicity?

AC: Studies have shown that disparities exist in access to and use of dental care, especially between rural and urban areas. So, we decided to look at dental visits by urbanicity.


Q: Were you surprised by any of the findings in this report?

AC: We were surprised that the percentage of adults aged 18-64 with a dental visit in the past 12 months was significantly different between those residing in urban and rural areas.


Q: What is the take home message in this report?

AC: This report examined urban-rural differences in dental care use among adults aged 18-64, and its variation by sex, race and ethnicity, and family income as a percentage of the federal poverty level.


Q: Anything else that you would like share from the report?

AC: It has been reported that persons living in rural areas were less likely to have a preventive dental visit, but more likely to seek emergency dental treatment than those residing in urban areas. As shown in this report, the lower percentage of dental care utilization in rural areas may be attributed to the lower density of dental care providers in these areas.


QuickStats: Percentage of Adults Aged 18 Years or Older with Diagnosed Chronic Obstructive Pulmonary Disease, by Urbanization Level and Age Group — National Health Interview Survey, United States, 2019

July 2, 2021

In 2019, the percentage of adults aged 18 years or older with diagnosed chronic obstructive pulmonary disease (COPD) was higher among those living in nonmetropolitan areas (8.0%) than among those living in metropolitan areas (4.0%).

Percentages were higher in nonmetropolitan areas for adults aged 45–64 years (10.0% versus 4.8%) and aged 65 years or older (14.5% versus 9.5%), but the difference by urbanization level was not statistically significant for adults aged 18–44 years (1.9% versus 1.2%).

The prevalence of diagnosed COPD increased with age in both nonmetropolitan and metropolitan areas.

Source: National Center for Health Statistics, National Health Interview Survey, 2019. https://www.cdc.gov/nchs/nhis.htm

https://www.cdc.gov/mmwr/volumes/70/wr/mm7026a3.htm


QuickStats: Percentage of Adults Aged 18 or Older with Diagnosed Diabetes by Urbanization Level and Age Group

May 7, 2021

mm7018a4-fIn 2019, the percentage of adults aged 18 years or older with diagnosed diabetes was higher among those living in nonmetropolitan areas (12.4%) than among those living in metropolitan areas (8.9%).

Percentages of adults with diagnosed diabetes were higher in nonmetropolitan than metropolitan areas for those aged 18–44 years (3.5% versus 2.3%) and 45–64 years (15.2% versus 11.6%).

Among adults aged 65 years or older, the difference by urbanization level (21.9% in nonmetropolitan areas versus 19.8% in metropolitan areas) did not reach statistical significance.

The prevalence of diagnosed diabetes increased with age in both nonmetropolitan and metropolitan areas.

Source: National Center for Health Statistics, National Health Interview Survey, 2019. https://www.cdc.gov/nchs/nhis.htm

https://www.cdc.gov/mmwr/volumes/70/wr/mm7018a4.htm


Urban-Rural Differences in Drug Overdose Death Rates, 1999-2019

March 17, 2021

Questions for Holly Hedegaard, Health Statistician and Lead Author of “Urban-Rural Differences in Drug Overdose Death Rates, 1999-2019.”

Q: How do drug overdose death rates in urban and rural areas compare?

HH: Over the past 20 years, rates of drug overdose deaths have increased in both urban and rural areas. Rates in rural areas were higher than in urban areas from 2007 through 2015, but in 2016 that pattern changed. From 2016 through 2019, rates have been higher in urban areas than in rural areas.

Although urban rates are higher than rural rates nationally, for 5 states (California, Connecticut, North Carolina, Vermont, and Virginia), rates are higher in rural areas than in urban areas.


Q: Is this the most recent data you have on this topic?  When do you plan on releasing 2020 data?

HH: Final 2020 data won’t be released until the end of 2021. In the interim, monthly provisional estimates of drug overdose death rates are available at https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm


Q: Was there a specific finding in the data that surprised you from this report?

HH: In this report, we looked at trends in rates for drug overdose deaths involving certain types of opioids, including natural and semisynthetic opioids. This group includes such drugs as hydrocodone, oxycodone, and codeine – drugs that are often thought of as prescription opioids. In looking at the trends from 1999 through 2019, the rates of drug overdose deaths involving natural and semisynthetic opioids were higher in rural than in urban areas from 2004 through 2017, but in 2018 and 2019, the urban and rural rates were similar, because of a decline in the rates in rural areas. We will continue to monitor whether this decline in the rate continues.


Q: What is the take home message for this report?

HH: The key messages from this report are: 1) for the past 20 years, drug overdose death rates have increased in both urban and rural areas, and 2) there are urban-rural differences in the rates of drug overdose deaths involving specific types of drugs. For example, for the past 20 years, rates of drug overdose deaths involving cocaine or heroin have been consistently higher in urban areas than in rural areas. In contrast, in recent years, rates of drug overdose deaths involving psychostimulants (such as methamphetamine) have been higher in rural areas than in urban areas.


Q: Do you think rural counties will go back to having higher drug overdose death rates in the future?

HH: It’s impossible to predict what will happen in the future. While a lot of resources have been devoted to prevention and treatment of drug overdose in recent years, new drugs are becoming available all the time. NCHS will continue to monitor drug overdose deaths to identify patterns to help inform public health efforts.


QuickStats: Death Rates Attributed to Excessive Cold or Hypothermia† Among Persons Aged15 Years or older, by Urban-Rural Status and Age Group

February 19, 2021

In 2019, among persons aged 15 years or older, death rates attributed to excessive cold or hypothermia were higher in rural areas than in urban areas across every age group.

Crude rates were lowest among those aged 15–34 years at 0.2 and 0.5 per 100,000 population in urban and rural areas, respectively.

Rates increased with age, with the highest rates among those aged 85 years or older at 4.6 in urban areas and 8.6 in rural areas. Differences between urban and rural rates also increased with age.

Source: National Center for Health Statistics, National Vital Statistics System, Mortality Data 2019. https://wonder.cdc.gov/mcd-icd10.html

https://www.cdc.gov/mmwr/volumes/70/wr/mm7007a6.htm


Motor Vehicle Traffic Death Rates Among Adolescents and Young Adults Aged 15–24, by Urbanicity: United States, 2000–2018

October 8, 2020

Questions for Sally Curtin, Health Statistician and Lead Author of “Motor Vehicle Traffic Death Rates Among Adolescents and Young Adults Aged 15–24, by Urbanicity: United States, 2000–2018.”


Q: Was there a specific finding in the data that surprised you from this report?

SC: The finding that the difference in MVT death rates between persons aged 15-24 and 25 years and over has narrowed so much since 2000 so that the rate is only 7% higher for 15-24 year-olds in 2018.


Q: How did you obtain this data for this report?

SC: These data are from the National Vital Statistics System and come from the information from death certificates in the United States.  All of the rates in this report are reproducible from the CDC WONDER online database.


Q: How do you classify urban and rural areas?

SC: The National Center for Health Statistics developed a scheme (the latest published in 2013) to classify the urbanicity of counties by combining information on whether the county was considered to be part of a metropolitan area and the population of the county.  Based on this, there are four categories of Metropolitan (urban) counties, from largest to smallest, and two categories of rural counties.


Q: Is this the first report on motor vehicle deaths with an urban and rural breakdown?  Is there any trend data that goes back further than 2000?

SC: A recent NCHS report examined trends in MVT deaths by urban-rural classification but it was for all ages combined.  This is the first report to focus on trends in younger adults, aged 15-24, by urban-rural.

There is MVT trends data prior to 2000, although they are not entirely comparable to the data from 1999 to the present.  However, trends from 1980-1999 rates are generally downward.


Q: What is the take home message for this report?

SC: There has been great progress in reducing death rates to young adults aged 15-24, for whom this has been a leading cause of death.  However, the disparity in rates that still exist between rural and urban counties shows that there is more work to be done, particularly in the most rural areas.

 


QuickStats: Rates of Deaths Attributed to Unintentional Injury from Fire or Flames by Age Group and Urbanization Level

August 28, 2020

In 2018, the death rates attributed to unintentional injury from fire or flames were lowest among those aged 15–24 years and highest among those aged 75 years or older.

In rural areas, death rates decreased with age from 2.0 per 100,000 for persons aged 0–4 years to 0.3 for those aged 15–24 years, and then increased with age to 5.6 for those aged 75 years or older.

The pattern was similar for urban areas, where rates were 0.5 per 100,000 for persons aged 0–4 years, decreased to 0.1 for those aged 15–24 years, and then increased with age to 2.8 for those aged 75 years or older.

Across all age groups, death rates were approximately two to four times higher in rural areas compared with urban areas.

Source: National Center for Health Statistics, National Vital Statistics System, mortality data; 2018. https://www.cdc.gov/nchs/nvss/deaths.htm.

https://www.cdc.gov/mmwr/volumes/69/wr/mm6934a8.htm 


Prevalence of Children Aged 3–17 Years With Developmental Disabilities, by Urbanicity: United States, 2015–2018

February 19, 2020

Questions for Ben Zablotsky, Ph.D., Health Statistician and Lead Author of “Prevalence of Children Aged 3–17 Years With Developmental Disabilities, by Urbanicity: United States, 2015–2018.”

Q: Why did you decide to focus on urbanicity among children with developmental disabilities?

BZ: Thanks to previous research, we know that children with developmental disabilities typically require more health care and educational services than their typically developing peers, and we also know that children living in rural areas have greater unmet medical needs when compared to children living in urban areas.  For these two reasons, it is possible, that children with developmental disabilities living in rural areas could represent some of the most vulnerable when it comes to receiving a variety of health care services.  This report attempts to answer this question, by exploring the prevalence of selected developmental disability conditions and use of related services in rural and urban areas.  It serves as a follow-up to a previous Pediatrics article written by myself and Lindsey Black, along with colleagues from the National Center for Health Statistics, National Center on Birth Defects and Developmental Disabilities, and the Maternal and Child Health Bureau, titled “Prevalence and Trends of Developmental Disabilities among Children in the United States: 2009-2017


Q: How did you obtain this data for this report and what is considered a developmental disability?

BZ: Data come from the 2015-2018 National Health Interview Survey, a timely and nationally representative survey.  Developmental disabilities examined in this report were attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, blindness, cerebral palsy, moderate to profound hearing loss, learning disability, intellectual disability, seizures in the past 12 months, stuttering or stammering in the past 12 months, or any other developmental delay. Children whose parents answered that their child had one or more of these conditions were classified as having any “developmental disability.”


Q: Can you summarize how the data varied by types of developmental disabilities and service utilization in rural and urban areas?

BZ: During 2015-2018, children were more likely to be diagnosed with ADHD and cerebral palsy in rural areas than urban areas.  Meanwhile, children with developmental disabilities living in rural areas were less likely to have seen a mental health professional, therapist, or had a well-child check-up in the past 12 months than their urban peers.  Children with developmental disabilities in rural areas were also less likely to be receiving Special Education or Early Intervention Services.


Q: Was there a specific finding in the data that surprised you?

BZ: Children with developmental disabilities often need specialty and mental health services.  It was surprising to see that approximately half of children with developmental disabilities living in rural areas had not seen a mental health professional, specialist, or therapist in the past year.


Q: What is the take home message for this report?

BZ: There was a higher prevalence of children with developmental disabilities in rural areas compared with urban areas. Furthermore, among children with developmental disabilities, those living in rural areas were less likely to use a range of health care and educational services compared with their urban peers.  Additional research exploring the pathways to the diagnosis and treatment of developmental disabilities in both urban and rural areas, with a focus on the availability of resources to pay for services as well as access to trained specialty providers, could provide insight into the disparities seen in this report.


Fact or Fiction: Do women who live in rural counties in the U.S. give birth at an earlier age than women in large metropolitan counties?

October 17, 2018

Source: National Vital Statistics System, 2017

https://www.cdc.gov/nchs/data/databriefs/db323-h.pdf


Trends in Fertility and Mother’s Age at First Birth Among Rural and Metropolitan Counties: United States, 2007–2017

October 17, 2018

Questions for Danielle Ely, Health Statistician and Lead Author of “Trends in Fertility and Mother’s Age at First Birth Among Rural and Metropolitan Counties: United States, 2007–2017

Q: Why did you decide to look at fertility rates and mother’s age at first birth among rural and metropolitan U.S. counties?

DE: Rural and metropolitan counties have a variety of differences related to general health, birth outcomes, and mortality rates. However, we noticed that recent research did not focus on the overall fertility differences in these areas or maternal age, which can affect birth outcomes. Looking at these items can help us understand why we might see differences between rural and metro counties in births and birth outcomes.


Q: How did the findings vary by race?

DE: Patterns for total fertility rates were similar by race and Hispanic origin. There were higher total fertility rates in rural counties than in metropolitan counties among the three race and Hispanic origin groups in 2007. In 2017, this pattern was the same for non-Hispanic white and Hispanic women, but non-Hispanic black women had higher total fertility rates in small or medium metro counties compared with rural and large metro counties. Hispanic women had the highest total fertility rates for each urbanization level in both 2007 and 2017

Non-Hispanic white, non-Hispanic black and Hispanic women had lower ages at first birth in rural counties compared with both metro county types. This was true in both 2007 and 2017, and differences between county types widened over this time.


Q: How did the findings vary by mean age of mothers at first birth?

DE: Mean age at first birth was lower in rural counties than small or medium metro counties and large metro counties from 2007-2017. Each of the three race and Hispanic origin groups had lower mean age at first birth in rural counties compared with metropolitan counties.


Q: Is there any comparable trend data prior to 2007?

DE: We have not computed trend data on total fertility rates or mean age at first birth by urbanization level prior to 2007.


Q: What is the take home message in this report?

DE: The important message in this report is that there are differences in the fertility rates and mean age at first birth between rural and metro areas, and these differences have gotten larger over time. These trends are generally the same by race and Hispanic origin. Information on differences in birth rates and maternal age by urbanization level can inform decisions on resource allocation and ultimately lead to improvement in infant and maternal health.