DRUG DISPARITIES IN RURAL AREAS OF THE UNITED STATES: A SYSTEMATIC LITERATURE REVIEW

Abstract

Background: Health disparities are widely prevalent in rural and urban communities. Previous research has identified health disparities disproportionally affecting rural areas. Poor, rural regions of the U.S. are stereotyped to be the epicenters of the opioid epidemic. This systematic review seeks to identify and characterize whether prescription drug access, drug errors, and drug safety issues affect rural areas more than urban areas and what factors may be contributing to health disparities. Methods: Five databases were searched: CINAHL, EMBASE, Ovid MEDLINE, PsycInfo, and PubMed, using the following search terms: ‘rural and urban drug errors’, ‘rural and urban drug safety’, and ‘rural drug disparities’. The results’ abstracts were formatted into spreadsheets and reviewed using the following inclusion criteria: (1) research including an intervention (excluding systematic reviews), (2) research conducted in the United States, (3) research involving at least 1 prescription drug, and (4) research comparing results between urban and rural populations. Duplicate articles appearing in multiple databases were deleted. Data were extracted from these articles to identify the location, study population, data source/methodology, measured outcome, clinical content (drug), clinical setting, general results, and results relevant to urban/rural populations. Finally, the articles were categorized based on the results as positive, negative, none, mixed, or inconclusive to measure how rural populations were affected. Results: There were 109 articles included. 59 (54%) articles showed a negative disparity for rural areas, 16 (15%) showed a positive outcome for rural areas, 16 (15%) showed mixed outcomes for rural areas, 12 (11%) showed no difference between rural and urban areas, and 6 (6%) were inconclusive. For opioids, rural populations had worse outcomes than urban populations (55% negative, 14% positive). For drug overdoses (excluding opioid-focused studies), rural populations had positive outcomes (0% negative, 25% positive). For vaccines, rural populations had worse coverage (73% negative, 13% positive). For hepatitis drugs (excluding vaccinations), rural populations had mixed outcomes (0% negative, 0% positive). For sexual health drugs (excluding hepatitis), rural populations fared worse (33% negative, 0% positive). For antibiotics, rural areas had worse outcomes (33% negative, 0% positive). For cardiovascular drugs, rural areas had negative outcomes (57% negative, 14% positive). For diabetes drugs, rural areas had mixed outcomes (0% negative, 0% positive). For cancer drugs, rural populations fared worse (57% negative, 0% positive). For mental health drugs, rural communities had worse outcomes (50% negative, 13% positive). For other drugs excluded from the previous categories, rural populations fared worse (64% negative, 27% positive). Discussion: As hypothesized, the majority of the studies included in the review described negative effects in rural areas. However, certain topics that did not describe a negative disparity for rural areas were non-opioid-focused drug overdoses, hepatitis drugs (excluding vaccinations), sexual health drugs (excluding hepatitis), antibiotics, and diabetes drugs. Negative disparities described for rural areas were opioids, vaccines, cardiovascular drugs, cancer drugs, and mental health drugs. Further research is required to explore the rural disparities associated with these classes of drugs and to identify and describe whether disparities are exacerbated in populations of color.