Rural–urban disparities in healthcare access among individuals with osteoarthritis in Portugal: a cross-sectional analysis of the 2019 National Health Survey

Abstract

Background: Osteoarthritis (OA) is a leading cause of musculoskeletal pain worldwide, with a greater impact on rural populations. Although preliminary findings suggest disparities in healthcare access for rural residents with OA, further research is needed to fully understand this issue. Aim: This study aimed to examine healthcare access disparities between rural and urban areas among individuals with self-reported OA living in Portugal. Methods: This study involves a cross-sectional secondary analysis of data from the 2019 Portuguese National Health Interview Survey (NHIS), focusing on individuals who self-reported OA. The prevalence of variables related to healthcare access was estimated, including the frequency of healthcare visits, waiting times for medical care, and the impact of financial factors. The odds ratio (OR) for healthcare access between rural and urban residents, adjusted for confounding, was estimated using multivariable logistic regression models. An age-stratified analysis was also performed. Results: A total of 4095 individuals with self-reported OA were included. Confounder-adjusted OR estimates revealed that living in rural areas was associated with a higher likelihood of not accessing physiotherapy treatments (OR 0.680, 95% CI 0.518–0.892), particularly among individuals under 65 years old. Additionally, rural residents were more likely (OR 1.775, 95% CI 1.197–2.633) to experience delays in healthcare services due to distance or transportation issues, with this disparity most pronounced among individuals aged 65 to 79 years. Conclusion: These findings highlight disparities in healthcare access between rural and urban residents with OA in Portugal, underscoring the need for targeted interventions to improve healthcare availability and reduce inequities.