Chronic health conditions and health care affordability issues among U.S. rural and urban adults

Purpose Chronic health conditions and rurality are associated with each other and with higher risks of medical debt. Less is known about the intersection of chronic conditions and health care affordability issues as they relate to rurality. The objective of this study is to determine whether rural/urban differences exist in associations between chronic conditions and health care affordability issues. Methods Using data from the 2022 National Health Interview Survey, we conducted survey-weighted bivariate analyses comparing rates of chronic conditions and multimorbidity by rurality, followed by adjusted multivariate logistic regression models examining associations between health care affordability issues, chronic conditions, and multimorbidity. Major Findings Compared to urban residents, rural residents reported significantly higher rates of nearly all chronic conditions, multimorbidity (3+ chronic conditions: 26.7% vs 18.3%, P <.001), problems paying medical bills (13.7% vs 11.0%, P =.004), and inability to pay medical bills (9.6% vs 6.8%, P <.001). After adjustment, certain chronic conditions and multimorbidity were associated differentially with health care affordability issues across the full, urban-only, and rural-only subsamples. Conclusions Adults living in rural areas of the U.S. may have higher rates of chronic conditions and be more likely to experience health care affordability issues than their urban counterparts. Differing patterns by multimorbidity and rurality indicate that policy interventions addressing medical debt should be targeted to chronic condition types and tailored by rurality.