Group Differences in Health Needs and Service Utilization Among Rural and Urban Refugees Resettled in the United States

Background: More than 3 million refugees representing diverse regions of the world have been resettled in the US. Exposure to war and conflict places resettled refugees at a higher risk of health, mental health and substance use problems compared with the general population. However, refugees are not a homogenous group and differences exist between refugee men and women and among refugees from various regions of the world. Moreover, significant differences exist among rural and urban refugees in terms of health and behavioral health outcomes. These differences have not been adequately examined among resettled refugees. Taking into account that a large number of refugees who are offered resettlement arrive from rural areas, there is a considerable need to explore these differences.

Methods: A cross-sectional study design and data from a publicly available national survey, the New Immigrant Survey (NIS-2003-1) were used to examine the self-reported physical and behavioral health needs and service utilization of refugees resettled in the United States. A total of 123 variables pertaining to resettled refugees (n=552) were selected for this study. Questionnaires for the interview were developed by the NIS team and sought information on topics related to demographics and health along with other variables of sociological interest. All analyses were conducted using Stata version 16. Bivariate relationships between group status of resettled refugees, i.e., gender, rural vs. urban were examined using chi-square tests for categorical variables. The dependent variables (DV’s) of interest in this study were those that pertained to physical health, behavioral health and service utilization. These variables were a composite of variables of multiple diagnosed physical health conditions, mental health and substance use issues and utilization of a health service or hospitalization. Next, to examine the relationship between group status and the dependent variables, logistic regression was used and health (yes/no), behavioral health (yes/no), and service utilization (yes/no) were regressed on group status and all covariates.

Results: Overall, refugee women fared worse than refugee men, and rural refugees fared worse than urban refugees. Resettled refugee women from rural origins were further marginalized and reported lower education levels (p<.05), poor English comprehension (p<.05), and higher childhood poverty (p<.001). Moreover, compared to those from urban settings, health service utilization was higher among resettled refugee women from rural areas (p<.05).

Conclusion & Implications: Given the current health status and job skills of rural refugee women, the risk for prolonged financial hardship for the families of these women may be anticipated. Considering that a large number of refugees arrive from rural areas of origin, and may have compromised health even prior to their refugee experience, special attention must be given to issues specific to rural populations such as poverty, low levels of education, low health literacy, poor health and behavioral health, and low job skills. If left unaddressed, the combined effect of these risk factors will continue to marginalize rural refugees, especially women with young children. This impact will be felt by children in terms of negative outcomes at schools, homes and personal well-being and likely be inter-generational.