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Defining Urban and Rural Areas in U.S. Epidemiologic Studies

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Abstract

Among epidemiologists, there has been increasing interest in the characteristics of communities that influence health. In the United States, the rural health disparity has been a recent focus of attention and made a priority for improvement. While many standardized definitions of urban and rural exist and are used by social scientists and demographers, they are found in sources unfamiliar to health researchers and have largely not been used in public health studies. This paper briefly reviews some available definitions of urban and rural for American geographic subunits and their respective strengths and weaknesses. For example, some definitions are better suited than others for capturing access to health care services. The authors applied different definitions to breast cancer incidence rates to show how urban/rural rate ratio comparisons would vary by choice of definition and found that dichotomous definitions may fail to capture variability in very rural areas. Further study of the utility of these measures in health studies is warranted.

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References

  1. Diez Roux AV. Invited commentary: places, people, and health. Am J Epidemiol. 2002;155:516–519.

    Article  PubMed  Google Scholar 

  2. O'Campo P. Invited commentary: advancing theory and methods for multilevel models of residential neighborhoods and health. Am J Epidemiol. 2003;157:9–13.

    Article  PubMed  Google Scholar 

  3. Oakes JM. The (mis)estimation of neighborhood effects: causal inference for a practicable social epidemiology. Soc Sci Med. 2004;58:1929–1952.

    Article  PubMed  Google Scholar 

  4. Koushik A, King WD, McLaughlin JR. An ecologic study of childhood leukemia and population mixing in Ontario, Canada. Cancer Causes Control. 2001;12:483–490.

    Article  PubMed  CAS  Google Scholar 

  5. Swan SH, Brazil C, Drobnis EZ, et al. Geographic differences in semen quality of fertile U.S. males. Environ Health Perspect. 2003;111:414–420.

    Article  PubMed  Google Scholar 

  6. Parks SE, Housemann RA, Brownson RC. Differential correlates of physical activity in urban and rural adults of various socioeconomic backgrounds in the United States. J Epidemiol Community Health. 2003;57:29–35.

    Article  PubMed  CAS  Google Scholar 

  7. Adgate JL, Eberly LE, Stroebel C, et al. Personal, indoor, and outdoor VOC exposures in a probability sample of children. J Expo Anal Environ Epidemiol. 2004;14(Suppl 1):S4–S13.

    Article  PubMed  CAS  Google Scholar 

  8. U.S. Department of Health and Human Services. One Department Serving Rural America: HHS Rural Task Force Report to the Secretary, 2002. Available at: ftp://ftp.hrsa.gov/ruralhealth/PublicReportJune2002.pdf. Accessed September 23, 2005.

  9. Galea S, Vlahov D. Urban health: evidence, challenges, and directions. Annu Rev Public Health. 2005;26:341–365.

    Article  PubMed  Google Scholar 

  10. Vlahov D, Galea S. Urbanization, urbanicity, and health. J Urban Health. 2002 Dec;79(4 Suppl 1):S1–S12.

    Google Scholar 

  11. Vlahov D, Galea S. Urban health: a new discipline. Lancet. 2003;362:1091–1092.

    Article  PubMed  Google Scholar 

  12. WWAMI Rural Health Research Center. Rural Definitions: What is Rural? Available at: http://www.fammed.washington.edu/wwamirhrc/rucas/ruca_definitions.html. Accessed September 23, 2005.

  13. Bingenheimer JB, Raudenbush SW. Statistical and substantive inferences in public health: issues in the application of multilevel models. Annu Rev Public Health. 2004;25:53–77.

    Article  PubMed  Google Scholar 

  14. Hiotis K, Ye W, Sposto R, Goldberg J, Mukhi V, Skinner K. The importance of location in determining breast conservation rates. Am J Surg. 2005 Jul;190(1):18–22.

    Article  Google Scholar 

  15. U.S. Bureau of the Census. Geographic Comparison Table: GCT-PH1-R Population, Housing Units, Area, and Density (Geographies Ranked by Total Population), 2000, Census 2000 Summary File 1 (SF 1) 100-Percent Data. Available at: http://factfinder.census.gov. Accessed September 23, 2005.

  16. Goodall C, Kafadar K, Tukey J. Computing and using rural versus urban measures in statistical applications. Am Stat. 1998;52:101–111.

    Article  Google Scholar 

  17. U.S. Bureau of Census. ZIP Code® Tabulation Areas (ZCTA™). 2004. Available at: http://www.census.gov/geo/ZCTA/zctafaq.html. Accessed September 23, 2005.

  18. U.S. Bureau of Census, Urban and Rural Definitions. Available at: http://www.census.gov/population/censusdata/urdef.txt. Accessed September 23, 2005.

  19. U.S. Bureau of Census. Census 2000 Urban and Rural Classification. Available at: http://www.census.gov/geo/www/ua/ua_2k.html. Accessed September 23, 2005.

  20. U.S. Bureau of Census. Census 2000 Summary File 3 Technical Documentation, p. B-54, 2002. Available at: http://www.census.gov/Press-Release/www/2002/sumfile3.html. Accessed September 23, 2005.

  21. U.S. Bureau of Census. Population, Housing Units, Area, and Density: 2000. Available at: http://factfinder.census.gov/servlet/SAFFPeople?_sse=on. Accessed September 23, 2005.

  22. U.S. Bureau of Census Urban and Rural Population: 1900 to 1990. Available at: http://factfinder.census.gov/servlet/SAFFPeople?_sse=on. Accessed September 23, 2005.

  23. U.S. Bureau of Census. Population, Housing Units, Area and Density: 2000. United States-Urban/Rural and Inside/Outside Metropolitan Area. Available at: http://factfinder.census.gov/servlet/SAFFPeople?_sse=on. Accessed September 23, 2005.

  24. Prehn AW, West DW. Evaluating local differences in breast cancer incidence rates: a census-based methodology (United States). Cancer Causes Control. 1998 Oct;9(5):511–517.

    Article  CAS  Google Scholar 

  25. Ricketts T, Johnson-Webb K, Taylor P. Definitions of Rural: A Handbook for Health Policy Makers and Researchers. Washington: US Department of Health and Human Services; 1998:1–12.

    Google Scholar 

  26. Hewitt M. Defining “rural” areas: impact on health care policy and research. In: Gesler WM, Ricketts TC, eds. Health in Rural North America. New Brunswick: Rutgers University Press; 1992:25–54.

    Google Scholar 

  27. Johnson-Webb K. What is rural? Issues and considerations. J Rural Health. 1997;13:254–256.

    Google Scholar 

  28. U.S. White House Office of Management and Budget. Metropolitan Areas Lists I-IV, 1995. Available at: http://www.whitehouse.gov/omb/bulletins/95-04attachintro.html. Accessed September 23, 2005.

  29. U.S. White House Office of Management and Budget, Press release 2003-18: OMB announces 49 new Metropolitan Statistical Areas 2003. Available at http://www.whitehouse.gov/omb/pubpress/2003-18.pdf. Accessed September 23, 2005.

  30. U.S. White House Office of Management and Budget. Part IX: Standards for Defining Metropolitan and Micropolitan Statistical Areas, Notice, December 27, 2000. Available at: http://www.census.gov/population/www/estimates/00-32997.pdf. Accessed September 23, 2005.

  31. U.S. White House Office of Management and Budget. Update of statistical area definitionsand additional guidance on their uses. Bulletin no. 05-02, 2005. Available at http://www.whitehouse.gov/omb/bulletins/fy05/b05-02.html. Accessed September 23, 2005.

  32. U.S. Census Bureau. Metropolitan and Micropolitan Statistical Area Definitions. Available at: http://www.census.gov/population/www/estimates/metrodef.html. Accessed September 23, 2005.

  33. U.S. Census Bureau. Population and Percent Distribution by Core-Based Statistical Area (BCSA) Status for the United States, Regions, and Divisions: 1990, 2000, and 2003 (CBSA-EST2003-09). Available at: http://www.census.gov/population/www/estimates/Estimates%20pages_final.html. Accessed September 23, 2005.

  34. U.S. Census Bureau, Population Division. Rankings for Metropolitan Statistical Areas: April 1, 2000 to July 1, 2003 (CBSA-EST2003-04). Available at: http://www.census.gov/population/www/estimates/metropop/PopTable04.xls. Accessed September 23, 2005.

  35. U.S. Census Bureau, Population Division. Annual Estimates of the Population of Metropolitan and Micropolitan Statistical Areas: April 1, 2000 to July 1, 2003 (CBSA-EST2003-01). Available at: http://www.census.gov/population/www/estimates/metropop/PopTable04.xls. Accessed September 23, 2005.

  36. Centers for Disease Control. Unintentional deaths from drug poisoning by urbanization of area—New Mexico, 1994–2003. MMWR Morb Mortal Wkly Rep. 2005;54(35):870–873.

    Google Scholar 

  37. Centers for Disease Control and Prevention. SMART: Selected Metropolitan/Micropolitan Area Risk Trends, Smart BRFSS. Updated June 22, 2005. Available at: http://www.cdc.gov/brfss/smart/faqs.htm. Accessed September 23, 2005.

  38. Slifkin RT, Randolph R, Ricketts TC. The changing metropolitan designation process and rural America. J Rural Health. 2004;20:1–6.

    Article  PubMed  Google Scholar 

  39. Hart LG, Larson EH, Lishner DM. Rural definitions for health policy and research. Am J Public Health. 2005 Jul;95(7):1149–1155.

    Article  Google Scholar 

  40. Ghelfi L, Parker T. A county-level measurement of urban influence. Rural Dev Perspect. 1995;12:32–41.

    Google Scholar 

  41. Baer LD, Johnson-Webb KD, Gesler WM. What is rural? A focus on urban influence codes. J Rural Health. 1997;13:329–333.

    PubMed  CAS  Google Scholar 

  42. ERS/USDA Briefing Room-Measuring Rurality: Urban Influence Codes. Economic Research Service USDA, 2003. Available at: http://www.ers.usda.gov/briefing/Rurality/UrbanInf/. Accessed September 23, 2005.

  43. U.S. Department of Agriculture, Economic Research Service. ERS/USDA Briefing Room-Measuring Rurality: 1993 Urban Influence Codes. Available at: http://www.ers.usda.gov/briefing/Rurality/UrbanInf/1993UIC.htm. Accessed September 23, 2005.

  44. Baer LD, Johnson-Webb KD, Gesler WM. What is rural? A focus on urban influence codes. J Rural Health. 1997;13:329–333.

    PubMed  CAS  Google Scholar 

  45. U.S. Department of Agriculture, Economic Research Service. ERS/USDA Briefing Room-Measuring Rurality: Rural-Urban Continuum Codes. Available at: http://www.ers.usda.gov/briefing/rurality/RuralUrbCon/. Accessed September 23, 2005.

  46. Larson SL, Fleishman JA. Rural–urban differences in usual source of care and ambulatory service use: analyses of national data using Urban Influence Codes. Med Care 2003;41:65–74.

    Google Scholar 

  47. Hawley ST, Chang S, Risser D, et al. Colorectal cancer incidence and mortality in Texas 1990–1992: a comparison of rural classifications. J Rural Health. 2002;18:536–546.

    PubMed  Google Scholar 

  48. Hall SA, Kaufman JS, Millikan RC, Ricketts TC, Herman D, Savitz DA. Urbanization and breast cancer incidence in North Carolina, 1995–1999. Ann Epidemiol. 2005 Nov;15(10):796–803.

    Article  PubMed  Google Scholar 

  49. Bennett T, Skatrud JD, Guild P, et al. Rural adolescent pregnancy: a view from the South. Fam Plann Perspect. 1997;29:256–260, 267.

    Article  PubMed  CAS  Google Scholar 

  50. U.S. Department of Agriculture, Economic Research Service. ERS/USDA Briefing Room: Measuring Rurality: Rural-Urban Commuting Area Codes. Available at: http://www.ers.usda.gov/briefing/Rurality/RuralUrbanCommutingAreas/. Accessed September 23, 2005.

  51. Weeks WB, Kazis LE, Shen Y, Cong Z, Ren XS, Miller D, Lee A, Perlin JB. Differences in health-related quality of life in rural and urban veterans. Am J Public Health. 2004 Oct;94(10):1762–1767.

    Article  Google Scholar 

  52. University of Washington School of Medicine. The Use of RUCAs in Health Care. Available at: http://www.fammed.washington.edu/wwamirhrc/rucas/use_healthcare.html. Accessed September 23, 2005.

  53. University of Washington School of Medicine. Zip Code RUCA Approximation Methodology. Available at: http://www.fammed.washington.edu/wwamirhrc/rucas/methods.html. Accessed September 23, 2005.

  54. WWAMI Rural Health Research Center. Importance and Availability of Rural-Urban Taxonomies. Available at: http://www.fammed.washington.edu/wwamirhrc/rucas/ruca_definitions.html. Accessed September 23, 2005.

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Acknowledgement

The authors would like to thank reviewers for their constructive comments.

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Authors and Affiliations

  1. Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Susan A. Hall PhD

Authors
  1. Susan A. Hall PhD
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  2. Jay S. Kaufman
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  3. Thomas C. Ricketts
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Correspondence to Susan A. Hall PhD.

Additional information

Hall and Kaufman are with the Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Ricketts is with the North Carolina Rural Health Research and Policy Analysis Center, Cecil G. Sheps Center for Health Services Research, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Hall is currently with Worldwide Epidemiology, GlaxoSmithKline, P.O. Box 13398, Five Moore Drive, Research Triangle Park, NC 27709-3398, USA.

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Hall, S.A., Kaufman, J.S. & Ricketts, T.C. Defining Urban and Rural Areas in U.S. Epidemiologic Studies. JURH 83, 162–175 (2006). https://doi.org/10.1007/s11524-005-9016-3

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