Geographic Access Measure for Primary Care in Rural Areas

Investigators: Mark Holmes, PhD, Paul Delamater, PhD

Objective: A key issue in the urban-rural disparity policy debate is the use of different definitions of rural. This study sought to: (1) assess the degree to which rural definitions identify the same areas as rural; and (2) assess rural-urban disparities identified by each definition across socioeconomic, demographic, and health access and outcome measures.

Methods: The study determined the rural status of each census tract and calculated the rural-urban disparity resulting from each definition, as well as across the number of definitions in which tracts were designated as rural (rurality agreement). Using 8 federal rural definitions, the study examined the population in 72,506 census tracts. Population characteristics included percent with a bachelor’s degree, income below 200% poverty, population density, percent with health insurance and whether various health care services were within 30 minutes driving time of the tract centroid.

Findings: The rural population varied from slightly < 6.9 million people to >75.5 million across definitions. The largest rural-urban disparities emerged using Urban Influence Codes. Urbanized Area and Urbanized Cluster tended to generate smaller disparities. Population characteristics such as population density and percent white had notable differences across levels of rurality, while others such as percent with a bachelor’s degree and income below 200% poverty varied consistently.

Policy Implications: The study suggests that rural-urban populations and disparities are sensitive to the specific definition used. The relative strength of definitions varied across population characteristics. Researchers and policymakers should carefully consider the choice of outcome and region when deciding the most appropriate rural definition.

Project Products: 

Manuscript
  • Long JC, Delamater PL, Holmes GM. Which Definition of Rurality Should I Use?: The Relative Performance of 8 Federal Rural Definitions in Identifying Rural-Urban Disparities. Medical care. 2021 Oct;59(10 Suppl 5):S413.
View the manuscript

 

Presentations, webinars, and refereed conference papers and posters