This study examined the intersection of rurality and community area deprivation using a nine-state sample of inpatient hospitalizations among children (<18 years of age) from 2011. One state from each of the nine US census regions with substantial rural representation and varying degrees of community vulnerability was selected. An area deprivation index was constructed and used in conjunction with rurality to examine differences in the rate of ACSC hospitalizations among children in the sample states. A mixed model with both fixed and random effects was used to test influence of rurality and area deprivation on the odds of a pediatric hospitalization due to an ACSC within the sample. Of primary interest was the interaction of rurality and area deprivation. The study found rural counties are disproportionality represented among the most deprived. Within the least deprived counties, the likelihood of an ACSC hospitalization was significantly lower in rural than among their urban counterparts. However, this rural advantage declines as the level of deprivation increases, suggesting the effect of rurality becomes more important as social and economic advantage deteriorates. We also found ACSC hospitalization to be much higher among racial/ethnic minority children and those with Medicaid or self-pay as an anticipated source of payment. These findings further contribute to the existing body of evidence documenting racial/ethnic disparities in important health related outcomes.

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Where you are born, the school you attend, your highest level of education, your race, age, and sex, these are all things that can directly, or indirectly impact your health. The social determinants of health is a phrase that can better be used to sum them all up. It refers to the social situation you exist in, and how that affects your ability to purchase healthy foods or obtain the medical care you need, and so much more. When it comes to certain measurements of health, people who fall within certain groups or populations, for example, minorities, or people of lower socio-economic statuses (SES), tend to have worse results than their white, or higher SES counterparts. These differences in health outcomes are referred to as disparities. As social scientists, healthcare professionals, and anyone with the means to address these disparities, we are ethically obligated to do so. There are already several initiatives aimed at addressing the social determinants of health. Through these initiatives, those in need are provided with things such as food vouchers, ride vouchers, and health education. What is missing, are organized studies with specific goals and appropriate sample sizes to address the efficacy of these initiatives. Once we have more such studies to provide us with data that supports the efficacy of these interventions, we can then advocate for policies that will make these resources widely available and encourage health equity. / Urban Bioethics