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Older Adults Living in Rural Areas are More Likely to Skip Health Care Due to Cost

Rural areas, already home to 20 million Americans ages 50 and older, are experiencing faster growth of their older adult population than urban areas. While there can be many benefits to living in non-metropolitan areas, residents face longstanding health care access challenges that contribute to well-documented health disparities compared to urban areas. Despite growing populations of older adults in rural areas, few studies have analyzed rural–urban or racial and ethnic disparities within the population. A recent AARP Public Policy Institute report, in addition to survey work from AARP Research, looked into some of these issues, illuminating such disparities and how they show up in everyday life.

Older Rural Residents More Likely to Forgo Medical Care Due to Cost

The AARP Public Policy Institute report compared health care access, health behaviors, and health conditions among older adults living in rural versus urban areas in 2019. Among other findings, the report found that adults ages 50 to 64 living in rural areas were more likely to forgo medical care due to cost than those living in urban areas (15 percent vs. 13 percent).

Rural Health Disparities Differ by Race and Ethnicity

The report also examined health disparities by race and ethnicity. Among rural residents, Black and Hispanic adults ages 50 and older were much more likely than their White counterparts to have skipped medical care due to cost. Additionally, older Black and White adults living in rural areas were more likely to forgo medical care than those of the same racial group living in urban areas. Nearly 18 percent of Black adults ages 50 to 64 skipped care in rural areas, compared to 13 percent in urban areas. Among White adults ages 50 to 64, this gap was much smaller: 9 percent in rural areas compared to 8 percent in urban areas.

The bigger gap among Black older adults suggests that living in a rural area may exacerbate racial health disparities. Notably, however, the opposite was found among Hispanic older adults, with Hispanics living in urban areas more likely than Hispanics living in rural areas to forgo medical care due to cost (17 percent in urban areas vs. 16 percent in rural areas).

COVID-19 Pandemic Affected Rural Residents' Access to Care

To gain further insights into the health behaviors of mid-life and older adults living in rural areas, AARP Research conducted a survey of rural area residents ages 40 and older in November and December 2020, a time largely defined by the COVID-19 pandemic. The results show that nearly one-third of rural-living adults ages 40 and older had to delay or forgo needed medical care in the previous two years, with those in fair to poor health more likely to delay or skip care. Concern about social distancing during the COVID-19 pandemic was the top reason rural-living adults went without care. Cost of care was the second biggest concern, followed by lack of time and difficulty getting appointments. Other research has similarly found that many adults overall skipped medical care during the pandemic, suggesting the pandemic exacerbated the problem.  

High-Quality Data Needed to Make Policy Decisions

AARP’s recent research highlights the complexity of rural health issues. As we consider these and future findings, it’s important to understand that rural areas do not all look the same. Research results can differ depending on population size, demographics, and other factors. Further, different definitions of rural can make it difficult to compare datasets that can inform sound policy decisions. Data sources also vary in quality and often have small samples of rural residents. Larger samples of underrepresented groups – including racial and ethnic groups like American Indian/Alaska Natives and Native Hawaiian and Pacific Islanders – are needed to better understand the joint effect of factors like race/ethnicity and rural/urban place of residence on the health of older adults in the U.S.

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