Urban and Rural Patterns of Health Care Utilization Among People With Rheumatoid Arthritis and Osteoarthritis in a Large US Patient Registry

Abstract

Objective: Rural residence has been associated with health disparities in rheumatic diseases and other chronic conditions in the United States. This study aimed to determine if a relationship exists between geographic residence and health care utilization outcomes for people with rheumatoid arthritis (RA) and osteoarthritis (OA) in a US-wide rheumatic disease registry.

Methods: Participants were in FORWARD, The National Databank for Rheumatic Diseases, a US-wide rheumatic disease longitudinal cohort completing questionnaires between 1999 and 2019. Health care utilization variables (ie, medical visits and diagnostic tests) from six-month questionnaires were analyzed by geographic categories (small rural/isolated, large rural, and urban). Double selection LASSO with Poisson regression was used to assess the best model when examining the association between health care utilization variables and geographic residence.

Results: Among 37,802 participants with RA, urban residents were more likely than small rural residents to use in-person health care by most measures including physician visits and diagnostic tests. Urban residents reported more rheumatologist visits (incidence rate ratio [IRR], 1.22; 95% confidence interval [95% CI], 1.18-1.27) but fewer primary care visits (IRR 0.90; 95% CI 0.85-0.94). Among 8,248 participants with OA, urban residents were also more likely than rural residents to report health care utilization by most measures.

Conclusion: Individuals residing in urban areas were more likely than those in rural areas to report in-person health care utilization. Specifically, urban residents with RA were more likely to report rheumatologist visits, but less likely to report primary care visits. Less disparity existed in OA health care utilization, although an urban-rural disparity still existed by most measures.

Figure 1

Incidence rate ratio (IRR) from the double selection least absolute shrinkage and selection operator (LASSO) with Poisson regression models for health care utilization outcome variables in six month questionnaires. Bars show the incidence rate ratio (IRR) ± 95% confidence interval (95% CI). GP = primary care/general practitioner; OA = osteoarthritis; RA = rheumatoid arthritis.