{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T02:12:21Z","timestamp":1793412741069,"version":"4.5.0"},"reference-count":45,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,3,8]],"date-time":"2024-03-08T00:00:00Z","timestamp":1709856000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine rural\u2013urban disparities in substance use disorder treatment access and continuation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources and Study Setting<\/jats:title>\n                    <jats:p>We analyzed a 2016\u20132018 U.S. national secondary dataset of commercial insurance claims.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>This cross\u2010sectional study examined individuals with a new episode of opioid, alcohol, or other drug use disorders. Treatment initiation and engagement rates, and rates of using out\u2010of\u2010network providers for these services, were compared between rural and urban patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Collection<\/jats:title>\n                    <jats:p>We included individuals 18\u201364\u2009years old with continuous employer\u2010sponsored insurance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Principal Findings<\/jats:title>\n                    <jats:p>\n                      Patients in rural settings experienced lower treatment initiation rates for alcohol (36.6% vs. 38.0%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), opioid (41.2% vs. 44.2%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and other drug (37.7% vs. 40.1%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) use disorders, relative to those in urban areas. Similarly, rural patients had lower treatment engagement rates for alcohol (15.1% vs. 17.3%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), opioid (21.0% vs. 22.6%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and other drug (15.5% vs. 17.5%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) use disorders. Rural patients had higher out\u2010of\u2010network rates for treatment initiation for other drug use disorders (20.4% vs. 17.2%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and for treatment engagement for alcohol (27.6% vs. 25.2%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006) and other drug (36.1% vs. 31.1%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) use disorders.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These findings indicate that individuals with substance use disorders in rural areas have lower rates of initial and ongoing treatment, and are more likely to seek care out\u2010of\u2010network.<\/jats:p>\n                  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