Recognizing that where people live affects their health, Jennifer Weiss, MD, MS, associate professor, Gastroenterology and Hepatology, and partners at the University of Wisconsin Health Innovation Program (HIP) have developed a more nuanced way to identify health disparities in Wisconsin’s rural and urban areas.

Their work is reflected in “WCHQ Health Disparities Report: Rural and Urban Populations,” a new report from the Wisconsin Collaborative for Healthcare Quality (WCHQ). The report synthesizes data from 25 health systems and medical clinics to show where gaps in health outcomes and care exist across the state.

Dr. Weiss explained that in the previous version of the report, areas were defined as simply either “urban” or “rural.” Those broad descriptions didn’t capture the difference between, for example, rural areas with few resources related to health and rural areas that are more affluent.

The lack of specificity has masked disparities in health outcomes and care, and hampered the creation or application of policies and programs that address a specific area of the state. 

“We needed to account for the unique characteristics that influence health across and within rural and urban areas,” Dr. Weiss said.

Six Distinct Groups

For the new report, she and the HIP team identified six distinct groups:

1. Rural underserved
2. Rural
3. Rural advantaged
4. Urban underserved
5. Urban
6. Urban advantaged

Those six groups were identified by examining health-related characteristics (for example, health care capacity, economic status, and health status) of every ZIP code in Wisconsin.

The team then evaluated multiple performance metrics within four measures of population health—vaccinations, screenings, risk factors and chronic disease—across those six groups and found a wide range of substantial disparities. The report shows:

• People living in rural underserved areas are experiencing substantial disparities in colorectal cancer screening and are much less likely to be tobacco-free if they have heart disease;
• Rural areas classified as advantaged have a much lower HPV vaccination rate;
• There were substantial disparities in the urban underserved population in two areas: childhood vaccinations and optimal control of heart disease; and  
• Those who are categorized as urban advantaged were screened for depression significantly less often than the highest performing group. 

“People experience health care in different ways, which are influenced by multiple factors. We know where people live is one of the biggest determinants of their health,” said Dr. Weiss, whose own research aims to improve rates of colorectal cancer screening in Wisconsin, especially in rural areas.

“To close those gaps and improve care for everyone will require a community-wide response from multiple stakeholders who can address issues such as poverty, housing, food insecurity and many other factors that have an impact on overall health,” she continued.

“With this second report, WCHQ is providing the information that is necessary to create, implement and measure the results of interventions and programs aimed at reducing health disparities,” said report co-author Matt Gigot, WCHQ director of performance measurement and analysis. “This information makes it possible to benchmark current performance and measure progress over time. Reliable data that are collected in a standardized and consistent way are essential when the goal is improving performance.”

Resources

• “WCHQ Report Identifies Health Disparities in Rural, Urban Locations.” Wisconsin Collaborative for Healthcare Quality press release. Published November 16, 2020. Accessed November 18, 2020.
• Wisconsin Health Disparities Report: Rural and Urban Populations, 2020. Accessed November 18, 2020.

This project is funded by a grant from the UW School of Medicine and Public Health’s Wisconsin Partnership Program to HIP Director and Population Health Sciences Professor Maureen Smith, MD, PhD, MPH. 

Banner: file photo of Dr. Jennifer Weiss. Credit: Clint Thayer/Department of Medicine.