While accessing health care is hard for rural residents, it’s even harder if they have disabilities, new research finds.
According to a study by the University of Minnesota Rural Health Research Center, individuals in rural counties have less access to primary care providers, dental care providers, and mental health care providers than either other rural residents or urban residents.
“As disability prevalence in a (rural) county goes up, so does the likelihood of the county being in a healthcare workforce shortage area,” Carrie Henning-Smith, lead researcher on the study and co-director of the Rural Health Research Center, said in an interview with the Daily Yonder.
That adds another harder twist to healthcare in rural areas, she said, because rural residents are already more likely to have a disability than their urban counterparts.
According to the U.S. Census Bureau, in 2021, a little more than one in seven rural residents (14.7%) reported having a disability, while just 12.6% of urban residents did.
Reasons for that are varied, Henning-Smith said.
“There are a lot of reasons, and it’s hard to pull them all apart, but it has to do with the structural factors that make up health outcomes in the first place,” she said. “You have higher rates of poverty (in rural areas); you have lower educational levels; you have more challenging access to care, especially specialty care, and challenges with just about every other social driver of health, like housing, transportation, and food access. And taken all together, those social drivers of health and those conditions where people live and work and play lead to higher disability risk for rural residents.”
Once those rural residents experience disabilities, their likelihood of not being able to find providers that can help them with their healthcare needs increases, the study found. The study looked at counties and whether they were rural or urban.
It also looked at whether counties were Health Professional Shortage Areas (HPSA) – a measurement of the availability of medical professionals for a given population and geography, which can be a useful indicator of provider access. The study also categorized the counties by age, and each age category was sorted into quartiles based on the percentage of the population with a disability – quartile one indicating the lowest disability rate and quartile four being the highest.
What the study found was that only 53.3% of urban counties with disabled residents were classified as HPSA’s, while 84.2% of rural counties with disabled individuals were categorized as HPSAs. The same held true for dental care, in which 73.8% of rural counties were dental health care HPSAs, butonly 45.6% of urban counties were.
As disability prevalence at the county level increased, health care professional shortages increased across those three measures, too, the study found. Rural counties with the highest disability prevalence among adults (ages 19 to 64) had the highest rates of HPSAs in primary care (95.5%), dental care (91.0%), and mental health care (96.7%) shortages.
The correlation of higher disability rates and lower access to healthcare providers puts rural residents at greater risk, Henning-Smith said.
“We can’t say anything about the causal directions here, but what I do know is that if you have a disability that comes with certain additional needs for care, it might come with needs for additional primary care or specialty care. It may come with needs for providers who understand you and understand your condition,” she said.
“In situations where there are workforce shortages, all of that is harder to come by… We also know that disability often happens in tandem with chronic conditions, and folks with disabilities are more likely to have many chronic conditions and those that require additional healthcare. All of that means that having a disability and living in a (healthcare) workforce shortage area, it’s harder to get the care you need, and that might lead to poor health outcomes.”
Although there is no causal relationship between access to care and disability, it’s easy to see how one could affect the other, she said.
“An example I can think of is if someone has diabetes and if they don’t receive a diagnosis in a timely manner, and they don’t have access to the care they need to manage their diabetes, that can lead to eventual disability,” she said. “We can see if someone loses a foot or has an amputation because their diabetes was not adequately managed … (there are) a number of disability conditions that may have been preventable had someone had access to the care they needed sooner.”
And while having access to healthcare one can afford doesn’t ensure a lack of disabilities, the study does give rise to the question about whether living in an area with long-standing workforce shortages may lead to poor disability outcomes, something Henning-Smith said is worthy of further study.
Moreover, she said, the study ultimately illustrates how the communities with the greatest need are often the ones least likely to be well-served.
“I was really struck by the magnitude of these findings,” Henning-Smith said. “The fact that more than 90% of rural counties in the highest quartile disability are health workforce shortage areas for just about every service line we looked at is abysmal and deeply concerning.”
And the health of the country is dependent on the health of residents in rural America, she said.
“We’re not going to improve our overall health outcomes as a country unless we invest in those communities with the greatest needs,” she said. “I think this shows that, while we found workforce shortages across all quartiles of disability, the fact that they were greater in those highest disability communities shows that we need targeted investments in the communities that are the least well-resourced.”
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