Urbanicity, Health, and Access to Services for People With Intellectual Disability and Developmental Disabilities.
Rural adults with IDD still miss basic preventive care even when they have disability services.
01Research in Context
What this study did
Stoni and team pulled national survey data on 1,300 U.S. adults with IDD. They split the sample into metro and non-metro ZIP codes. Then they counted who got cancer screens, dental cleanings, and routine check-ups in the past year.
What they found
Rural adults with IDD got 30 % fewer preventive services than city peers. They also rated their own health as 'poor' twice as often. Even when both groups had a case manager, country folks still missed more care.
How this fits with other research
Ummer-Christian et al. (2018) saw the same gap in kids' dental care. Their scoping review blamed dentist training, not distance. That match shows the rural problem spans ages and specialties.
Baker et al. (2025) extended the idea to technology. They found caregivers in well-served states called tech 'useful.' Stoni's rural families were the mirror: low service use, low tech use. Together the papers map a wider access desert.
van der Miesen et al. (2024) looked at research itself. They learned 78 % of UK health studies exclude adults with IDD. Stoni's data explain why: when rural adults are already invisible to clinics, they are also invisible to researchers.
Why it matters
You can't fix what you don't see. If your client lives outside a metro area, add a travel-time check to every care plan. Offer telehealth, mobile clinics, or group rides. Document the extra miles as a barrier in your notes. One added prompt can turn a missed mammogram into a saved life.
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Join Free →Open the client's file, check their address, and if it's non-metro add a preventive-care coordination goal with specific mile or minute limits.
02At a glance
03Original abstract
Previous research suggests that residence in non-metropolitan areas is associated with lower access to preventive care and poorer health. However, this research has been largely restricted to the general population, despite data demonstrating disparities in health status and access to healthcare services for people with intellectual and developmental disabilities (IDD). The current study examined several hypotheses involving the effects of rurality on access to preventive healthcare and services and health status: (1) individuals in non-metropolitan areas will have lower preventive healthcare utilization, (2) individuals in non-metropolitan areas will have poorer health outcomes, and (3) individuals in non-metropolitan areas will have poorer access to services. The current study uses data from the National Core Indicators (NCI) Adult Consumer Survey 2015-2016: Final Report which included Rural-Urban Commuting Area (RUCA) Codes for the first time. Results of logistic regression suggest that, despite connection to disability services, the health status and access to preventive healthcare services of people with IDD generally follow patterns similar to those observed in the general population. Namely, people with IDD in non-metropolitan areas have decreased access to healthcare services, preventive healthcare utilization, and health status. Despite some exceptions, it appears effects of rurality are not completely mitigated by current state and federal efforts.
American journal on intellectual and developmental disabilities, 2021 · doi:10.1352/1944-7558-126.6.492