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A comparison of hospital utilization in urban and rural areas of South CarolinaBackground: Previous studies have described health care utilization based on insurance status and ethnicity. Few investigations, however, have looked at rural populations in relation to distance in securing health care. Methods: The 2008 to 2009 Healthcare Cost and Utilization Project (HCUP) State Inpatient Database (SID) for South Carolina was used to assess the relationship of living in rural versus urban communities and the demographic variables related to insurance coverage. By use of bivariate and multivariate analyses, patient socio-demographic characteristics were explored for working-aged groups in relation to their income and for payer status (Medicaid or uninsured) relative to those privately insured. Results: Of hospitalizations, 68.89% were for those living in urban areas, 20.52% in large rural areas, 6.57% small rural areas, and 4.02% in isolated rural areas. Blacks lived predominantly in small rural (53.65%) and isolated rural communities (51.55%). As income decreased, the percentage of hospital admissions increased, from 5.83% for those earning $66,000 to 43.29% for those earning between $1 and $39,999. Conclusions: Hospital admissions may not be entirely dependent on race, income or insurance, but could also be influenced by geographic access. Further, having private insurance, higher incomes, and living in urban areas are positive predictors for better health outcomes.
Understanding the role of social norms in organ donation decision making among African American adultsBackground: African Americans (AAs) comprise a disproportionate number of those waiting on the national transplant list and are underrepresented among registered organ donors. While barriers to organ donation are well understood, little research has explored factors that facilitate interest in donation. Because AAs are often characterized by strong extended relationships and shared decision-making, social norms may be an influential factor in donation behavior. Utilizing the Theory of Reasoned Action, this study demonstrated the application of theory to understand the role social norms play in donation decisionmaking, among AAs. Methods: Self-administered questionnaires were completed by 425 AA adults residing in the metropolitan Atlanta area. Social norms were measured using a Likert scale consisting of two items that addressed perceptions of favorability of donation and levels of influence a loved one has over the participant’s donation decision making. Main outcomes assessed were donation intentions and expression of donation intentions via designation on one’s driver’s license. Results: Logistic regression results indicate that a loved one’s level of favorability of donation is associated with both intention (OR=2.14, p≤0.01) and expression (OR=1.71, p≤0.01); however, findings approached significance with the level of influence a loved one has on intentions (OR=1.47, p=0.07) but was not associated with expression (p>0.05). Conclusions: The results suggest that a loved one’s level of favorability has an effect on donation decision making, but, conversely, a loved one’s level of influence does not impact donation decision making. Focusing on social norms and encouraging communication may prove useful for future interventions to improve engagement in donation among AAs.