Dr. Paquette cited a recent report by the American College of Surgeons Health Policy Research Institute. "This study looked at small, isolated rural communities and found that there were 4.6 surgeons per 100,000 people, whereas that number in an urban community is 6.5 per 100,000," he said. "That number doesn't sound very big, but when you take into account a lower population density spread over a larger geographic area, the magnitude of the disparity in rural areas increases."

The study authors chose to analyze data on appendicitis because it affects all population groups consistently despite biological, socioeconomic, or behavioral factors, or other health problems a person may have. "Appendicitis has a consistent natural history that ultimately leads to perforation if untreated," Dr. Paquette said. "Virtually all patients who get appendicitis will eventually come to get medical attention, whether they decide to initially wait or not. We have seen this as an effective model to gauge access to timely health care."

Source: Dartmouth Hitchcock Medical Center