Rural and urban disparities in quality of life and health-related behaviors among chronically ill patients

Abstract

Introduction: The purpose of this study was to describe rural and urban disparities in quality of life and health-related behaviors among chronically ill patients. Additionally, effects of health status and health-related behaviors on healthcare utilization were investigated.

Methods: The study included 1239 chronically ill patients from primary care centers in rural areas (eligible patients; response rate: 62.0%). The analyzed group was compared with the urban group, homogeneous in respect of gender and age (n=1886). Quality of life (QoL) was measured using the World Health Organization Quality of Life Instrument Short Form (WHOQoL-Bref). The authors also used the Health Behavior Inventory (HBI).

Results: Only the results in Domain 4 (Environmental) were higher among patients from rural areas (13.6 vs 13.4, p=0.015) within the WHOQoL-Bref. Differences between rural and urban areas in the contributors to lower QoL referred to such variables as gender, height, body mass, BMI and level of healthcare utilization. Results of HBI were higher in patients from urban areas (85.0 vs 83.1, p<0.001). The differences in factors potentially contributing to lower levels of health behavior concerned gender, age, height, body mass, BMI, having a partner, number of chronic diseases and level of healthcare utilization. The authors observed among the rural patients fewer visits of district nurses (12.1 vs 15.3, p=0.003). Odds ratio (OR) for QoL in the case of place of residence (rural vs urban) was OR=1.341 (95% CI: 1.067-1.687).

Conclusions: Higher quality of life may reduce the level of healthcare utilization among residents of rural and urban areas. Educational programs, promoting health behaviors, should be primarily addressed to rural patients, men, younger individuals, patients with a lower number of chronic diseases, and those using healthcare services less often.