Rural/Urban Health Disparities in Missouri

BACKGROUND:   The Missouri Department of Health and Senior Services (MODHSS) Bureau of Health Care Analysis and Data Dissemination (BHCADD) collaborates with the MODHSS Office of Primary Care and Rural Health to publish a biennial report titled Health in Rural Missouri.   With input from the program, the most recent report was redesigned to include more data sources and additional graphical displays.

METHODS:   BHCADD staff have access to both demographic data and to many Missouri-specific data systems.  These provide a rich opportunity to analyze recent trends in health disparities between Missouri’s rural and urban populations.  After developing a methodology to define the rural/urban populations in Missouri, BHCADD analysts used SAS and Excel to track health conditions and status for many common indicators.  Where appropriate, comparisons were made between Missouri data and Healthy People 2020 targets.  Ongoing meetings and sharing of early drafts of the report with Rural Health staff ensured that the project was both on time and met the program’s needs.

RESULTS:   Missouri’s 2.23 million rural residents are overall less healthy than their urban counterparts and are more likely to die at an earlier age.  This is demonstrated in lower life expectancy and higher death rates.  The largest identified disparity involved motor vehicle deaths, for which the rural rate was more than twice both the urban rate and the Healthy People 2020 target.  Another finding was that urban residents are hospitalized at a significantly higher rate than rural residents.  Thus, a higher rate of urban residents receive hospital treatment for diseases such as cancer, but a higher rate of rural residents die from those diseases.  Rates of health risk factors such as smoking and lack of health screenings are also significantly higher for rural residents. 

CONCLUSIONS:   Evidence shows that rural Missourians face many challenges related to their health which create disparities in health status compared to their urban counterparts.  Overcoming these challenges requires sound regulation and policy.  These policies, however, may need to differ by region because of differences in the reality of healthcare between not only urban and rural populations, but also between the diverse rural populations of the state.  This is especially true when addressing issues related to access to health care services.   This will require a multi-faceted approach with many different stakeholders and rejection of a “one-size-fits-all” mentality.