Rural Health
Resources by Topic: Rural-urban differences
The Golden Hour Is Elusive in Rural Trauma: A 10-year Analysis from a Level I Trauma Center in Montana
Analyzed 4,213 trauma patients between 2012 and 2022 at a Level 1 trauma facility in Montana to determine whether trauma transfer patterns and rurality impacted outcomes. Discusses the goal of offering definitive care within 1 hour of injury and the impact of workforce shortages in rural areas.
Author(s): Jung G. Min, Maggie Smith, Michael S. Englehart, et al.
Citation: The American Journal of Emergency Medicine, 103, 127-131
Date: 05/2026
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Analyzed 4,213 trauma patients between 2012 and 2022 at a Level 1 trauma facility in Montana to determine whether trauma transfer patterns and rurality impacted outcomes. Discusses the goal of offering definitive care within 1 hour of injury and the impact of workforce shortages in rural areas.
Author(s): Jung G. Min, Maggie Smith, Michael S. Englehart, et al.
Citation: The American Journal of Emergency Medicine, 103, 127-131
Date: 05/2026
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A Closer Look at Rural Nursing Homes
Compares characteristics of nursing homes in rural and urban areas including patient population data, distribution, and ownership. Also discusses payer mix, healthcare quality, and staffing levels. Highlights changes between 2015 and 2025 for some data.
Author(s): Priya Chidambaram, Alice Burns, Robin Rudowitz
Date: 04/2026
Sponsoring organization: KFF
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Compares characteristics of nursing homes in rural and urban areas including patient population data, distribution, and ownership. Also discusses payer mix, healthcare quality, and staffing levels. Highlights changes between 2015 and 2025 for some data.
Author(s): Priya Chidambaram, Alice Burns, Robin Rudowitz
Date: 04/2026
Sponsoring organization: KFF
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Geographic Variation in Average Salary Expense Among Rural Hospitals Nationwide, 2018–2022
Examines the change in hospital wages between 2018–2019 and 2021–2022, with a focus on the geographic variation in these changes among Critical Access Hospitals (CAHs) and rural Prospective Payment System (PPS) hospitals. Describes the variation in average salary expense per full-time equivalent (FTE) employee for rural hospitals from 2018 to 2022. Appendices include the median salary expense per FTE of rural hospitals each year by U.S. Census region, state Medicaid expansion status, Core-Based Statistical Area (CBSA), Frontier and Remote Area (FAR) code, and by state.
Date: 04/2026
Sponsoring organization: North Carolina Rural Health Research Program
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Examines the change in hospital wages between 2018–2019 and 2021–2022, with a focus on the geographic variation in these changes among Critical Access Hospitals (CAHs) and rural Prospective Payment System (PPS) hospitals. Describes the variation in average salary expense per full-time equivalent (FTE) employee for rural hospitals from 2018 to 2022. Appendices include the median salary expense per FTE of rural hospitals each year by U.S. Census region, state Medicaid expansion status, Core-Based Statistical Area (CBSA), Frontier and Remote Area (FAR) code, and by state.
Date: 04/2026
Sponsoring organization: North Carolina Rural Health Research Program
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Medicare Wage Index Trends in Rural and Urban Hospitals Before and During the Low Wage Index Policy, 2018–2022
Provides an overview of the wage index and its role in hospital reimbursement and financial stability. Describes the pattern of wage index values for rural and urban prospective payment system (PPS) hospitals from 2018 to 2022. Explores the impact of the low-wage index policy (LWIP), which was implemented in fiscal year 2020, and the potential implications of its discontinuation in fiscal year 2025.
Author(s): Saleema Karim, George Pink, Kristie Thompson, Mark Holmes
Date: 04/2026
Sponsoring organization: North Carolina Rural Health Research Program
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Provides an overview of the wage index and its role in hospital reimbursement and financial stability. Describes the pattern of wage index values for rural and urban prospective payment system (PPS) hospitals from 2018 to 2022. Explores the impact of the low-wage index policy (LWIP), which was implemented in fiscal year 2020, and the potential implications of its discontinuation in fiscal year 2025.
Author(s): Saleema Karim, George Pink, Kristie Thompson, Mark Holmes
Date: 04/2026
Sponsoring organization: North Carolina Rural Health Research Program
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Average Salary Expense in Rural and Urban Hospitals in 2022 Compared with 2018, by Hospital Characteristics
Explores how the COVID-19 pandemic may have affected wage disparities across rural and urban hospitals. Describes the median wages by total employee full-time equivalents (FTE) for rural and urban hospitals from 2017-2018 to 2021-2022. Compares the growth in labor cost for rural and urban hospitals by selected hospital characteristics, including system affiliation, hospital ownership, and number of acute care beds.
Date: 04/2026
Sponsoring organization: North Carolina Rural Health Research Program
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Explores how the COVID-19 pandemic may have affected wage disparities across rural and urban hospitals. Describes the median wages by total employee full-time equivalents (FTE) for rural and urban hospitals from 2017-2018 to 2021-2022. Compares the growth in labor cost for rural and urban hospitals by selected hospital characteristics, including system affiliation, hospital ownership, and number of acute care beds.
Date: 04/2026
Sponsoring organization: North Carolina Rural Health Research Program
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Average Salary Expense in Rural and Urban Hospitals Before and During the Low Wage Index Policy, 2018–2022
Examines and compares wage patterns of Critical Access Hospitals (CAHs), Rural Prospective Payment System (PPS) hospitals, and Urban PPS hospitals as related to the Low Wage Index Policy (LWIP) in effect from 2020-2022. Utilizes hospital data from the Centers for Medicare & Medicaid Services (CMS) Healthcare Cost Report Information System (HCRIS) between 2018 and 2022 and analyzes median salaries. Discusses the impact of Medicare payments and LWIP on hospitals.
Author(s): Saleema Karim, George Pink, Kristie Thompson, Mark Holmes
Date: 04/2026
Sponsoring organization: North Carolina Rural Health Research Program
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Examines and compares wage patterns of Critical Access Hospitals (CAHs), Rural Prospective Payment System (PPS) hospitals, and Urban PPS hospitals as related to the Low Wage Index Policy (LWIP) in effect from 2020-2022. Utilizes hospital data from the Centers for Medicare & Medicaid Services (CMS) Healthcare Cost Report Information System (HCRIS) between 2018 and 2022 and analyzes median salaries. Discusses the impact of Medicare payments and LWIP on hospitals.
Author(s): Saleema Karim, George Pink, Kristie Thompson, Mark Holmes
Date: 04/2026
Sponsoring organization: North Carolina Rural Health Research Program
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The Distribution of the Youth Behavioral Health Workforce in Rural and Urban America in 2025
Examines the distribution of school counselors; youth, family, or school psychologists; youth or family mental health nurses; school social workers; and pediatric psychiatrists or behavioral pediatricians across rural and urban areas of the U.S. Features statistics with breakdowns by provider type and location by 6 levels of population density, and a county-level map with shadings showing rural counties with and without youth behavioral health clinicians.
Author(s): Janessa M. Graves, Sara C. Woolcock, Lisa A. Garberson, C. Holly A. Andrilla
Date: 04/2026
Sponsoring organization: WWAMI Rural Health Research Center
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Examines the distribution of school counselors; youth, family, or school psychologists; youth or family mental health nurses; school social workers; and pediatric psychiatrists or behavioral pediatricians across rural and urban areas of the U.S. Features statistics with breakdowns by provider type and location by 6 levels of population density, and a county-level map with shadings showing rural counties with and without youth behavioral health clinicians.
Author(s): Janessa M. Graves, Sara C. Woolcock, Lisa A. Garberson, C. Holly A. Andrilla
Date: 04/2026
Sponsoring organization: WWAMI Rural Health Research Center
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Factors Associated With Mortality in Appalachian Nursing Homes During the COVID-19 Pandemic
Examines neighborhood characteristics related to Appalachian nursing home (NH) mortality during the COVID-19 pandemic. Analyzes 1,259 NHs in Appalachia for COVID-19 death rates and overall mortality, with breakdowns according to NH characteristics, patient sociodemographics, and rurality.
Author(s): Erica Gigas, Baiming Zou, Lorinda A Coombs, et al.
Citation: The Permanente Journal, 1-9
Date: 04/2026
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Examines neighborhood characteristics related to Appalachian nursing home (NH) mortality during the COVID-19 pandemic. Analyzes 1,259 NHs in Appalachia for COVID-19 death rates and overall mortality, with breakdowns according to NH characteristics, patient sociodemographics, and rurality.
Author(s): Erica Gigas, Baiming Zou, Lorinda A Coombs, et al.
Citation: The Permanente Journal, 1-9
Date: 04/2026
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Influenza Vaccination Coverage Among Nursing Home Residents and Health Care Personnel — United States, 2024–25 Influenza Season
Reports on influenza vaccination during the 2024–25 influenza season for nursing home residents and healthcare workers. Provides pooled influenza coverage data by facility for nursing home residents and for nursing home personnel, with data by urbanicity for metropolitan, micropolitan, and noncore areas.
Author(s): Jeneita M. Bell, Kira Barbre, Lu Meng, et al.
Citation: MMWR (Morbidity and Mortality Weekly Report), 75(15), 195-201
Date: 04/2026
Sponsoring organization: Centers for Disease Control and Prevention
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Reports on influenza vaccination during the 2024–25 influenza season for nursing home residents and healthcare workers. Provides pooled influenza coverage data by facility for nursing home residents and for nursing home personnel, with data by urbanicity for metropolitan, micropolitan, and noncore areas.
Author(s): Jeneita M. Bell, Kira Barbre, Lu Meng, et al.
Citation: MMWR (Morbidity and Mortality Weekly Report), 75(15), 195-201
Date: 04/2026
Sponsoring organization: Centers for Disease Control and Prevention
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Comparing the Care, Distance Traveled, and Health Workforce Clinician Mix for Rural and Urban Commercially Insured Enrollees With Opioid Use Disorder
Examines characteristics of opioid treatment in rural and urban communities across the United States. Utilizes 2019 commercial claims data from the Health Care Cost Institute (HCCI) to analyze rural versus urban differences in opioid use disorder and overdose diagnoses, healthcare utilization, healthcare visits by clinician type, average distance traveled to utilize healthcare, and location of received care.
Author(s): C. Holly A. Andrilla, Sara C. Woolcock, Lisa A. Garberson, Janessa M. Graves
Date: 04/2026
Sponsoring organization: WWAMI Rural Health Research Center
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Examines characteristics of opioid treatment in rural and urban communities across the United States. Utilizes 2019 commercial claims data from the Health Care Cost Institute (HCCI) to analyze rural versus urban differences in opioid use disorder and overdose diagnoses, healthcare utilization, healthcare visits by clinician type, average distance traveled to utilize healthcare, and location of received care.
Author(s): C. Holly A. Andrilla, Sara C. Woolcock, Lisa A. Garberson, Janessa M. Graves
Date: 04/2026
Sponsoring organization: WWAMI Rural Health Research Center
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