Rural-Urban Disparities in Mental and Behavioral Health Hospitalizations Among US Children Between 2017-2022

• In Event: When Distance Matters: Rural Healthcare Access and Disparities

Abstract

Research Objectives:

This study examines the association between rural-urban status and Mental and Behavioral Health Conditions (MBHC) hospitalizations among US children using administrative data and provides evidence-based insights into access barriers in rural areas.

Study Design and Methods:

This retrospective observational study utilizes hospitalization data from the 2017-2022 National Inpatient Sample (NIS) datasets of the Healthcare Cost and Utilization Project (HCUP). We defined MBHC as occurring when a child’s primary diagnosis record shows the presence of appropriate International Classification of Diseases, 10th Revision, Clinical Modification (ICD–10–CM) diagnostic codes for MBHC.

The dependent variable is the MBHC hospitalization status (i.e., whether a child was hospitalized for an MBHC). The primary independent variable is the rural versus urban status of the patient. We adjusted our model for a variety of covariates, including patients’ demographics, socioeconomic factors, hospital characteristics, insurance coverage, length of stay, hospital and admission characteristics, and year of hospitalization. Our analysis used survey-weighted logistic regression analysis. Adjusted odds ratios (ORs) were estimated, and average marginal effects were calculated post-estimation.

Population Studied:

The study population included children aged 3-17 years with a primary MBHC diagnosis in the US during the study period (weighted N=1,032,187)

Principal Findings:

Our analysis revealed significant rural-urban disparities in children’s MBHC hospitalizations, with rural children having a 3-percentage-point lower probability of MBHC hospitalizations compared to their urban counterparts (p<0.001). We observed a strong age gradient, with adolescents (12-17 years) having a 29-percentage-point higher probability of MBHC hospitalizations compared to young children (3-5 years). Male children had a 6-percentage-point lower probability than females for MBHC hospitalizations. Significant racial/ethnic disparities were evident, with most minority children showing lower MBHC hospitalization probabilities compared to White children, except Native American children, who had a 1.8-percentage-point higher probability. Children with Medicare/Medicaid insurance had a higher probability than those with private insurance of MBHC hospitalizations. Regional variations were substantial, with Midwest hospitals showing 6.5 percentage points higher and Western hospitals showing 6.4-percentage-point lower MBHC hospitalization probabilities compared to Northeast facilities.

Conclusion:

Significant disparities in children’s MBHC hospitalizations exist across geographic, demographic, and socioeconomic lines. Rural children are less likely to be hospitalized for mental health conditions, raising concerns about access and underdiagnosis.

Policy Implications:

Our study highlights the need for greater focus on expanding telehealth, school-based programs, and rural mental health services. Policies must also address racial and ethnic disparities and ensure equitable healthcare access for children.

Author

• Gogoal Falia, Texas A&M University
  Presenting Author