Rural/Urban Differences among American Indian/Alaska Native Peoples in Health Care Access and Outcomes, 2019-2023

Area of Science:

• Public Health
• Health Services Research
• Health Disparities

Background:

• Health challenges for American Indian/Alaska Native (AI/AN) populations are known, yet rural-urban disparities in health and healthcare access remain under-examined.
• The Indian Health Service (IHS) plays a significant role, primarily serving rural AI/AN communities, necessitating an analysis of its impact on rural versus urban AI/AN health outcomes.

Purpose of the Study:

• To compare health status and healthcare access between rural and urban AI/AN adults.
• To investigate the influence of the Indian Health Service (IHS) on healthcare access and affordability for AI/AN individuals residing in different geographic locations.

Main Methods:

• Utilized data from the 2019-2023 National Health Interview Surveys, including adult respondents identifying as AI/AN.
• Classified respondents' county of residence as urban (metropolitan) or rural (non-metropolitan).
• Analyzed outcomes such as usual place of care, cost-related underuse of care, emergency room visits, clinic visits, medical bill worries, and self-rated health.

Main Results:

• Rural AI/AN adults reported greater socioeconomic risks (lower education, higher poverty) but had increased access to IHS compared to urban AI/AN adults.
• Rural AI/AN individuals were more likely to have a usual place of care (93.8% vs. 84.8%) and avoid cost-related underuse of care (75.9% vs. 65.3%) than urban counterparts.
• AI/AN adults utilizing IHS demonstrated better access to usual care and lower cost barriers, irrespective of their rural or urban residence.

Conclusions:

• Despite higher socioeconomic challenges, rural AI/AN adults experience more accessible and affordable healthcare, largely due to greater IHS utilization.
• The IHS is crucial in mitigating healthcare access and affordability barriers for AI/AN populations, particularly in rural areas.
• Addressing socioeconomic disparities remains important, but the findings highlight the positive impact of IHS on healthcare delivery for rural AI/AN individuals.