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Introduction:Despite improved outcomes when adults with congenital heart disease (ACHD) are cared for at specialized centers, these centers serve only a minority of patients. It has been suggested that rural patients may be less likely to attend care at ACHD centers than urban dwelling patients, contributing to disparities in care and outcomes. The goal of this study was to determine if healthcare utilization differs between rural and non-rural ACHD patients in Oregon.Methods:The Oregon All Payer All Claims (APAC) database for the years 2010-2012 was queried for adults 18 to 65 years of age with ICD-9 codes for congenital heart disease (CHD). A validated hierarchical algorithm was applied to classify diagnoses in the study cohort, excluding non-specific CHD and Marfan syndrome. Additional utilization variables were created by standard methods. Probabilities of utilization were estimated by mean predictions from logistic regression with age as a covariate.Results:A total of 5055 patients with CHD were identified; mean (SD) age was 43 (15) years. 2525 patients (50%) lived in the Portland metropolitan area, 1526 (30%) in other metropolitan areas of Oregon, and 1004 (20%) in rural areas. Rural-dwelling patients were more likely to receive Medicaid (42% vs 25%, p<0.001), and, after age adjustment, more likely to visit the emergency room (32% vs. 25%, p<0.001) and their primary care provider (78% vs 73%, p=0.004), but not cardiology providers of any type (p=0.4). In spite of distance, patients accessed specialized ACHD care about equally across regions (14% in the Portland area vs 16% in rural areas).Conclusions:ACHD patients in rural areas are high utilizers of emergency and primary care, but are not more likely to receive either specialized ACHD or general cardiology care. Initiatives to facilitate care coordination between local providers and specialized centers may improve the efficacy and outcome of care for rural dwelling individuals with ACHD.