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Urban influence codes reveal more about children's patterns of health care use and coverage

Studies using the categories Metropolitan Statistical Area (MSA, urban) and Nonmetropolitan Statistical Area (nonMSA, rural) have found differences between urban and rural children in health risks and health care. However, a new study shows that more specific Urban Influence Codes can shed additional light on children's health care patterns, which were not previously evident from the use of MSA/nonMSA categories. Researchers at the Agency for Healthcare Research and Quality (AHRQ) and colleagues analyzed two national health care databases: the 2002 Medical Expenditure Panel Survey and the 2002 Nationwide Inpatient Sample and State Inpatient Databases from the Healthcare Cost and Utilization Project.

County urbanicity is defined in both data sets by Urban Influence Codes that distinguish among children residing in and hospitals located in large metropolitan (metro) counties, small metro counties, micropolitan (large rural) counties, and noncore (small rural) counties. Based on these codes, greater percentages of children in large metro counties were Hispanic or black than in the other three counties. In micropolitan and noncore counties, higher proportions of children were below 200 percent of the Federal poverty level than in large metro and small metro counties.

Noncore areas had a greater percentage of children in fair or poor health compared with those in small metro and micropolitan counties. Most hospitals were located in large and small metro areas. Hispanic children residing in large metro counties were more likely to be uninsured than those in small metro counties. The proportion of children with medicine prescribed was generally lower in large metro areas compared with all other areas. Children in noncore areas were more likely to have a hospital stay and emergency department use than children in large metro areas. Children in large metro counties had longer average hospital stays and higher hospital charges per day compared with all other children. Over half of hospitalizations for noncore children occurred outside of noncore counties.

More details are in "Health care for children and youth in the United States: Annual report on patterns of coverage, utilization, quality, and expenditures by a county level of urban influence," by Frances M. Chevarley, Ph.D., Pamela L. Owens, Ph.D., Marc W. Zodet, M.S., and others, in the September 2006 Ambulatory Pediatrics 6(5), pp. 241-264.

Reprints (AHRQ Publication No. 06-R079) are available from the AHRQ Publications Clearinghouse.

Editor's Note: In a brief commentary, AHRQ researcher Denise Dougherty, Ph.D., and colleagues Lisa A. Simpson, M.B., B.Ch., M.P.H., and Marie C. McCormick, M.D., Sc.D., note that an analysis of data from AHRQ by urban influence code in Chevarley, et al., suggests that children living in rural areas are disproportionately poor, rely on public insurance, and have patterns of health care use that point to barriers to care access. The data also suggest that rural children have differing levels of care quality depending on the type of care assessed. Rural children may be particularly vulnerable to recent changes in Medicaid, which reduce benefits and increase copayments and cost-sharing for low-income families, note the authors. They suggest that improving care access to rural children should take an innovative approach, using health information technology to provide and coordinate care to children, perhaps using public health departments as hubs for care and care monitoring. See "Rural areas and children's health care coverage, use, expenditures, and quality: Policy implications," by Drs. Dougherty, Simpson, and McCormick, in the September 2006 Ambulatory Pediatrics 6(5), pp. 265-267.

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