Access to Care and Self-Rated Health Status: Comparison of Rural and Urban Immigrants in the US

Existing immigrant health literature has highlighted disparities among US immigrants but focused primarily on urban immigrants. To assess utilization patterns and differences in access to care, healthcare utilization, and health status between rural and urban immigrants. We conduct a cross-sectional secondary analysis using the National Health Interview Survey (NHIS) data from 2019-2023. Multivariable Ordinary Least Squares (OLS) regression models estimate the differences in immigrant health by their rural and urban location. 18-64-year-old foreign-born adults residing in the US rural or urban areas were included. Access to care indicators include health insurance, having a usual place of care, being unable to pay medical bills, and delayed filling prescriptions to save money. Healthcare utilization indicators include being in a hospital overnight, the number of urgent care or ER/ED visits, and whether the last visit was a wellness visit. Self-reported health measures the respondents' health status. Compared to urban, rural immigrants are significantly less likely to have private health insurance coverage (4 percentage points or pp) and urgent care visits (9 pp); and significantly more likely to have - usual sources of care (3 pp), problems paying medical bills (2 pp), delay in filling prescriptions (3 pp), emergency room/department visits (4 pp), and poor health (2 pp). This study highlights disparities in access to care and health outcomes among rural and urban immigrants. Policymakers should consider that the unique challenges faced by rural immigrants are further intensified by the difficulties of rural life in the US.