Geographic Disparity of Chronic Health Outcomes In Illinois

Introduction/Background:

Less than one-fifth of the US population lives in rural areas, yet, this population disproportionately experiences disability when compared to urban residents. This rural-urban disability divide is driven by factors such as limited access to healthcare and higher rates of poverty. Living with a disability may also be more difficult in rural areas as residents may lack access to specialized medical care and face limited accessible infrastructure. Illinois encompasses major metropolitan areas, however, much of the state is rural. This divide is the site of a major health justice concern and should be explored in order to begin understanding inequities in disability prevalence. Rural Illinois is made up of a predominantly white population, however, there are populations of racially marginalized people who are disproportionately impacted by poverty and at higher risk of negative health outcomes. This study aims to explore the impacts of poverty and urbanicity on health outcomes.

Methods:

This study used 2020-2024 the American Community Survey, supplementing them with the CDC 2024 PLACES data and the USDA 2023 rural-urban continuum codes. To explore the impacts of geographic disparity on adult health outcomes in Illinois, we ran a population-weighted linear spatial mixed model with a first-order queen contiguity conditional autoregressive random effect to account for tract-level spatial autocorrelation using R studio software.

Results:

Preliminary results show a geographic disparity of health outcomes by poverty and urbanicity, where there are higher morbidity risks in higher poverty tracts and rural areas. Census tracts with higher poverty and rurality had significantly higher total adult disability rates— by 0.55 percentage points (p<0.001), equivalent to a 4.70% increase relative to the mean adult disability rate in Illinois (11.8%). Also, tracts with higher poverty and rurality had significantly higher rates of: arthritis (p<0.001), diabetes (p<0.001), asthma (p<0.001), high blood pressure (p<0.001), chronic obstructive pulmonary disease (p<0.001), and coronary heart disease (p<0.001). Skin cancer, however, showed higher risks in lower poverty and higher rurality tracts (p<0.001). Additionally, analyses showed a racial disparity, with Black and non-white Hispanic populations at significantly higher risk in all of the disability and chronic illness categories examined.

Conclusions/Implications:

The preliminary, cross-sectional findings of this study highlight associations between poverty, race, health, and urbanicity in the state of Illinois. Future research examining longitudinal impacts and social determinants of health is warranted in order to address inequities and develop policy and interventions to address factors associated with disability. As social workers strive to promote the common good, building an equitable and just society means addressing geographic disparities to ensure no one is left behind. The rural-urban divide in Illinois plays a role in state legislature and thus puts rural residents at risk of not being heard on important issues, such as poverty and health outcomes. It is critical for social workers to be at the forefront of bridging this divide and to develop partnerships and co-create solutions that center marginalized populations.