Urban Residents With Arthritis Access More In-Person Care Than Rural Counterparts
Individuals with rheumatoid arthritis (RA) and osteoarthritis (OA) living in rural areas access significantly less in-person health care than those in urban settings, according to a study published in Arthritis Care & Research.
“This study sought to examine the relationship between urban versus rural residence and in-person health care utilization for people with RA and OA in the FORWARD Databank, a US-wide rheumatic disease longitudinal registry,” explained Luke Desilet, University of Nebraska Medical Center, Omaha, and coauthors.
Researchers selected the most recent pre-pandemic observations from participants between 1999 and 2019 and used Rural-Urban Commuting Area codes to categorize location. Health care use was assessed via participant questionnaires and analyzed using Poisson regression models with double-selection least absolute shrinkage and selection operator (LASSO) to adjust for confounders.
Of the 37 802 RA and 8248 OA participants, about 75% lived in urban areas. Compared to individuals in small rural areas, urban residents with RA were significantly more likely to have all health professional visits (incidence rate ratio [IRR], 1.16; 95% CI, 1.11–1.20), rheumatologist visits (IRR, 1.22; 95% CI, 1.18–1.27), other physician visits (IRR, 1.34; 95% CI, 1.26–1.43), and diagnostic tests (IRR, 1.12; 95% CI, 1.07–1.18). Similar disparities were seen in composite measures, including visits to rheumatologists, primary care, and physical or occupational therapy. Conversely, rural residents relied more heavily on primary care physicians alone.
Participants with OA showed similar trends: those in urban areas were more likely than small rural residents to see rheumatologists (IRR, 1.27; 95% CI, 1.11–1.46), undergo diagnostic testing (IRR, 1.15,; 95% CI, 1.03–1.28), and access composite care services (IRR, 1.12; 95% CI, 1.01–1.23). However, participants with OA living in large rural areas showed no significant increase in utilization compared to their small rural peers.
“This study highlights the need to implement health care delivery techniques and incentives to broaden access to rheumatologic care in rural communities,” concluded the study authors.
Reference
Desilet LW, Pedro S, Katz P, Michaud K. Urban and rural patterns of health care utilization among people with rheumatoid arthritis and osteoarthritis in a large US patient registry. Arthritis Care Res (Hoboken). 2025;77(3):412-418. doi:10.1002/acr.25192
