'The biggest reason for this appears to be that people in rural areas have less access to specialist physicians like cardiologists and endocrinologists.' 'People on Medicare with chronic conditions such as heart failure or diabetes who live in rural areas have higher death and hospitalization rates than their urban peers,' Johnston said. The paper was published in the December 2019 issue of Health Affairs. The study, led by Kenton Johnston, Ph.D., assistant professor of health management and policy at Saint Louis University College for Public Health and Social Justice, looked at data from Medicare patients who have chronic health problems.