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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.