Rural Health
Resources by Topic: Rural-urban differences
County-Level Social Determinants of Health and Suicide Mortality Trends Among Formerly Incarcerated Persons in North Carolina, 2010–2018
Assesses how county-level factors including educational attainment, unemployment, poverty, aging, racial composition, and rurality are associated with suicide mortality among formerly incarcerated people in North Carolina. Features statistics including mortality rate per 100,000 with breakdowns by year from 2010-2018 and rural or urban county.
Author(s): Monica E. Swilley-Martinez, Brian W. Pence, Kate Vinita Fitch, et al.
Citation: Heath & Justice, 14, 20
Date: 04/2026
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Assesses how county-level factors including educational attainment, unemployment, poverty, aging, racial composition, and rurality are associated with suicide mortality among formerly incarcerated people in North Carolina. Features statistics including mortality rate per 100,000 with breakdowns by year from 2010-2018 and rural or urban county.
Author(s): Monica E. Swilley-Martinez, Brian W. Pence, Kate Vinita Fitch, et al.
Citation: Heath & Justice, 14, 20
Date: 04/2026
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Characteristics of Firearm Injuries among Rural-Versus Urban-Residing Veterans Who Presented to VA Healthcare, 2010-2019
Presents a study using administrative data and electronic health records from VA health systems to compare firearm injuries among rural and urban veterans. Breaks down rural and urban veteran data by patient characteristics, such as age, marital status, and behavioral health diagnoses, among others.
Author(s): AnnaMarie S. O'Neill, Lauren A. Maxim, Tess A. Gilbert, et al.
Citation: Journal of Rural Health, 42(2), e70153
Date: 04/2026
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Presents a study using administrative data and electronic health records from VA health systems to compare firearm injuries among rural and urban veterans. Breaks down rural and urban veteran data by patient characteristics, such as age, marital status, and behavioral health diagnoses, among others.
Author(s): AnnaMarie S. O'Neill, Lauren A. Maxim, Tess A. Gilbert, et al.
Citation: Journal of Rural Health, 42(2), e70153
Date: 04/2026
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Driver Electronic Device Use in 2024
National data on driver use of electronic devices from 2015-2024. Features statistics on percentage of drivers holding cellphones to their ears, speaking with visible headsets, and visibly manipulating handheld devices while driving, with breakdowns including age, sex, race, and urban or rural location. Includes tables listing states banning texting and use of handheld cellphones while driving, as of June 2024.
Date: 04/2026
Sponsoring organization: National Highway Traffic Safety Administration
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National data on driver use of electronic devices from 2015-2024. Features statistics on percentage of drivers holding cellphones to their ears, speaking with visible headsets, and visibly manipulating handheld devices while driving, with breakdowns including age, sex, race, and urban or rural location. Includes tables listing states banning texting and use of handheld cellphones while driving, as of June 2024.
Date: 04/2026
Sponsoring organization: National Highway Traffic Safety Administration
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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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