Objective
To examine child and hospital demographics and children’s health care coverage, use,
expenditures, and quality by a county-level measure of urban influence.
Methods
Two national health care databases serve as the sources of data for this report: the
2002 Medical Expenditure Panel Survey (MEPS) and the 2002 Nationwide Inpatient Sample
(NIS) and State Inpatient Databases (SID) from the Healthcare Cost and Utilization
Project (HCUP). In both data sets, county urbanicity is defined by use of a collapsed
version of the 2003 Urban Influence Codes, to distinguish among children residing
in and hospitals located in large metropolitan (metro) counties, small metro counties,
micropolitan counties, and noncore counties.
Results
Demographics. In large metro counties, greater percentages of the child population are Hispanic
or black non-Hispanic than in small metro, micropolitan, and noncore counties; in
micropolitan and noncore counties, higher proportions of children are below 200% of
the federal poverty level than in large metro and small metro counties. Noncore areas
have a greater percentage of children in fair or poor health compared with those in
small metro and micropolitan counties. Most hospitals are located in large and small
metro areas, and large metro areas have a higher proportion of teaching hospitals
compared with other areas. Health care. In general, there were no overall differences by place of residence in the proportion
of children with and without insurance, although differences emerged in subpopulations
within Urban Influence Code types. Hispanic children residing in large metro counties
were more likely to be uninsured than those in small metro counties. Overall, the
proportion of children with at least one dental visit was larger in small metro areas
compared with both large metro and noncore areas. The proportion of children with
medicines prescribed was generally lower in large metro areas compared with all other
areas both overall and among subpopulations of children. Children in noncore areas
were more likely to have a hospital inpatient stay and any emergency department use
compared with children in large metro areas. Children in large metro counties had
longer average inpatient stays and a higher hospital inpatient charge per day compared
with children in all other counties. Although most hospitalizations for children from
large metro areas occurred in large metro areas, over half of hospitalizations for
noncore children occurred outside of noncore counties. Further, children from noncore
counties appear to be hospitalized for ambulatory sensitive conditions more than children
from all other areas.
Conclusions
County-level data analyses performed using a collapsed version of the Urban Influence
Codes with MEPS and HCUP data shed additional light on the health care patterns for
children that were not previously evident when only the dichotomous metropolitan/nonmetropolitan
geographic schema was used.
Key words
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Article Info
Publication History
Accepted:
June 30,
2006
Received:
February 28,
2006
Footnotes
The views expressed in this article are those of the authors and do not necessarily represent those of the Agency for Healthcare Research and Quality or the US Department of Health and Human Services.
Identification
Copyright
© 2006 Ambulatory Pediatric Association. Published by Elsevier Inc. All rights reserved.
