Insights from a large rural population laboratory. Health census '89 and '99

Area of Science:

• Public Health
• Epidemiology
• Health Services Research

Background:

• Rural areas face higher chronic disease rates (e.g., coronary heart disease) compared to urban areas.
• Limited data exists on health status, behaviors, and service utilization among rural populations.
• Socioeconomic factors significantly influence health outcomes and access to care.

Purpose of the Study:

• To assess health status, behaviors, and healthcare service use in a rural Central New York population.
• To identify disparities in preventive service utilization based on socioeconomic status and insurance coverage.
• To establish baseline data for tracking 10-year trends in rural health and inform intervention strategies.

Main Methods:

• Established a population laboratory (Health Census) in Otsego County, NY, conducting door-to-door enumeration.
• Collected data from 44,500 adults in 18,000 households on health screenings, risk factors, behaviors, and service use.
• Assessed cost-benefits of survey methods and included perceived health status and pediatric preventive care needs in HC '99.

Main Results:

• Achieved an 86% response rate in the Health Census '89 (HC '89).
• Identified significant socioeconomic gradients in preventive service use (screenings, mammograms, Pap smears).
• Uninsured or Medicaid-enrolled adults showed lower screening rates, higher smoking, and obesity rates.

Conclusions:

• HC '89 confirmed lagging health indicators in rural Central New York populations.
• Socioeconomic disparities in health service use are likely persistent, as suggested by HC '99 preliminary findings.
• Methodological advancements and survey results guide smaller rural counties in developing local health surveys and interventions.