The role of social cohesion in explaining rural/urban differences in healthcare access and health status among older adults in the mid-Atlantic United States

Social cohesion can influence health. It is higher among rural versus urban residents, but the burden of chronic disease is higher in rural communities. We examined the role of social cohesion in explaining rural/urban differences in healthcare access and health status. Rural (n = 1080) and urban (n = 1846) adults (ages 50+) from seven mid-Atlantic U.S. states completed an online, cross-sectional survey on social cohesion and health. We conducted bivariate and multivariable analyses to evaluate the relationships of rurality and social cohesion with healthcare access and health status. Rural participants had higher social cohesion scores than did urban participants (rural: mean = 61.7, standard error[SE] = 0.40; urban: mean = 60.6, SE = 0.35; adjusted beta = 1.45, SE = 0.54, p < .01). Higher social cohesion was associated with greater healthcare access: last-year check-up: adjusted odds ratio[aOR] = 1.25, 95% confidence interval[CI] = 1.17–1.33; having a personal provider: aOR = 1.11, 95% CI = 1.03–1.18; and being up-to-date with CRC screening: aOR = 1.17, 95% CI = 1.10–1.25. In addition, higher social cohesion was associated with improved health status: higher mental health scores (adjusted beta = 1.03, SE = 0.15, p < .001) and lower body mass index (BMI; beta = −0.26, SE = 0.10, p = .01). Compared to urban participants, rural participants were less likely to have a personal provider, had lower physical and mental health scores, and had higher BMI. Paradoxically, rural residents had higher social cohesion but generally poorer health outcomes than did urban residents, even though higher social cohesion is associated with better health. These findings have implications for research and policy to promote social cohesion and health, particularly for health promotion interventions to reduce disparities experienced by rural residents.

© This manuscript version is made available under the CC-BY-NC-ND 4.0 license https://creativecommons.org/licenses/by-nc-nd/4.0/

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Work Title The role of social cohesion in explaining rural/urban differences in healthcare access and health status among older adults in the mid-Atlantic United States
Access
Open Access
Creators
  1. Jennifer L. Moss
  2. Madison Hearn
  3. Yendelela L. Cuffee
  4. Britney M. Wardecker
  5. Erin Kitt-Lewis
  6. Casey N. Pinto
Keyword
  1. Social cohesion
  2. Rural health
  3. Older adults
  4. Healthcare access
  5. Health status
License CC BY-NC-ND 4.0 (Attribution-NonCommercial-NoDerivatives)
Work Type Article
Publisher
  1. Preventive Medicine
Publication Date June 29, 2023
Publisher Identifier (DOI)
  1. https://doi.org/10.1016/j.ypmed.2023.107588
Deposited March 26, 2024

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Version 1
published

  • Created
  • Added Rural-urban-cmmty-cohesion-health_manuscript-clean.docx
  • Added Creator Jennifer Moss
  • Added Creator Madison Hearn
  • Added Creator Yendelela Cuffee
  • Added Creator Britney M. Wardecker
  • Added Creator Erin Kitt-Lewis
  • Added Creator Casey Pinto
  • Published
  • Updated
  • Updated Keyword, Publication Date Show Changes
    Keyword
    • Social cohesion, Rural health, Older adults, Healthcare access, Health status
    Publication Date
    • 2023-08-01
    • 2023-06-29
  • Renamed Creator Jennifer L. Moss Show Changes
    • Jennifer Moss
    • Jennifer L. Moss
  • Renamed Creator Yendelela L. Cuffee Show Changes
    • Yendelela Cuffee
    • Yendelela L. Cuffee
  • Renamed Creator Casey N. Pinto Show Changes
    • Casey Pinto
    • Casey N. Pinto