Rural health disparities in asthma care and outcomes

J Allergy Clin Immunol. 2009 Jun;123(6):1220-5. doi: 10.1016/j.jaci.2008.12.1131. Epub 2009 Feb 23.


Fifty-nine million Americans (21% of the US population) live in rural areas of the United States. Compared with persons living in urban areas of the United States, rural populations have lower income, a higher rate of government versus private insurance, and decreased access to health care. Although there are reports of lower asthma prevalence in rural areas, the majority of these data have been published on international populations, with few available studies looking at American urban versus rural asthma prevalence on a national scale or comparing rural with nearby urban cohorts in the United States. A large body of literature, mainly generated from studies of rural Europe, suggests that lower prevalence might be due to beneficial effects of exposure to farm environments, but the extent to which this applies to the rural United States, where a smaller proportion of the population engages in farming, is unclear. The United States has the additional covariate of having a higher proportion of African Americans, who have a greater asthma burden than whites independent of socioeconomic status, clustered in cities. There are data indicating that rural patients have increased difficulty obtaining health care in general and limited data suggesting that they receive inferior care for asthma. Future work is needed to more clearly define asthma prevalence and morbidity among residents of the rural United States, as well as to identify interventions effective in this population.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • African Americans / statistics & numerical data
  • Asthma / economics*
  • Asthma / epidemiology*
  • Asthma / prevention & control*
  • European Continental Ancestry Group / statistics & numerical data
  • Health Services Accessibility / economics*
  • Health Services Accessibility / standards
  • Health Status Disparities
  • Healthcare Disparities / economics*
  • Healthcare Disparities / standards
  • Humans
  • Prevalence
  • Risk Factors
  • Rural Health Services / economics
  • Rural Health Services / standards
  • Rural Health*
  • Rural Population
  • Social Class
  • Socioeconomic Factors
  • United States / epidemiology
  • Urban Population