The Feasibility of Using Electronic Health Data for Research on Small Populations. Health issues


Rural communities are generally older populations and have higher rates of chronic conditions.155 People in rural counties are more likely than their urban counterparts to face food insecurity (i.e., reports of problems regarding quality, variety, or desirability of diet or eating patterns)156 which is associated with risks of diabetes and obesity.157 Rural populations are more likely to report fair to poor health status158 and to have higher rates of mortality, disability, and smoking and lower rates of physical activity.159

A culture of independence and self-reliance in many rural areas presents challenges to the implementation of public health programs,160 as well as to treatment for mental illness and substance abuse.161 While the prevalence of mental illness does not seem to differ between rural and urban areas (although documentation is poorer in rural areas), suicide rates are higher in rural communities.162 In addition, rural youth and young adults have higher use of alcohol and methamphetamines than their urban counterparts, with the degree of use increasing with degree of rurality.163 Although heightened awareness has increased enforcement, the production of methamphetamines has flourished in isolated rural settings due to the availability of abandoned buildings and anhydrous ammonia, a common fertilizer used by farmers as well as a key ingredient in methamphetamine production.164

Rural residents in some parts of the country face environmental health risks associated with agriculture, mining, and industrial pollution. Contaminated water is a risk in communities that rely on well-water, which is not subject to the Safe Water Drinking Act and therefore lacks monitoring and regulation.165 Rural counties with known sources of water pollution and air pollution have higher rates of cancer mortality, and rural coal-mining areas have higher overall mortality rates.166

Despite the known environmental health risks, rural health departments are less likely than urban departments to provide environmental surveillance, inspections, regulation, and licensing services or to employ environmental specialists or epidemiologists. Lack of resources has prevented many rural communities from developing the environmental workforce needed to address many of their environmental health risks.167

Rural health issues differ based on a community’s dependence on farming, as well as based on other characteristics. While farming once characterized most rural counties, by 2000 the portion of rural counties dependent on farming had declined to 20 percent.168 The shift from family farms to large corporate farms added environmental health risks.169 The potential for farm injuries, antibiotic-resistant infections from livestock production, exposure to pesticides, diesel, and solvents also accompany agricultural production, and are associated with cancer, respiratory health issues, reproductive outcomes and neurological disorders.170

Gaps in health insurance coverage are also an issue, particularly in rural counties that are not adjacent to an urban county, where nearly a quarter of residents were uninsured in 1998 and where employment in small businesses that do not offer health benefits is particularly common.171 One challenge in examining rural health issues is determining which urban-rural differences are due to distinct rural factors and which are due to the demographics of the people living there, such as employment characteristics and age. One analysis of BRFSS data found that once the analysis controlled for these factors, some urban-rural differences were reduced or even disappeared.172

There is also an important racial/ethnic component of rural health. Rural communities along the U.S./Mexico border, where nearly 67 percent of U.S. Hispanic residents live, are affected by social factors related to border crossing. The border population has been growing faster than the overall U.S. population growth, and many border areas lack much of the economic and health care infrastructure needed to support this growth, making access to health care a particular challenge.173 The growth of racial and ethnic minorities in non-border rural communities due to immigration and migrant or seasonal farm workers has also been accompanied by growing health disparities as these communities have yet to develop the capacity to overcome cultural and language barriers.174 In addition, nearly half of the U.S. Native American population, in which rates of alcoholism and substance abuse are particularly high, lives in rural areas (compared to 23 percent of the U.S. white population).175

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