Adapting the Index of Relative Rurality (IRR) to Estimate Rurality at the ZIP Code Level: A Rural Classification System in Health Services Research
BACKGROUND: Accurate analysis of health problems facing rural residents depends on how rurality is defined. Health services research relies frequently on the rural urban commuting area (RUCA) codes to estimate rurality at the small area level. We modified the county‐level Index of Relative Rurality...
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| Published in | The Journal of rural health Vol. 32; no. 2; pp. 219 - 227 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
England
Journal of Rural Health
01.03.2016
Blackwell Publishing Ltd Wiley Subscription Services, Inc |
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| Abstract | BACKGROUND: Accurate analysis of health problems facing rural residents depends on how rurality is defined. Health services research relies frequently on the rural urban commuting area (RUCA) codes to estimate rurality at the small area level. We modified the county‐level Index of Relative Rurality (IRR) to the ZIP code level (IRRZIP) to create an alternative small‐area‐level rural classification system. We then compared how the 2 rural classification systems differ in how rural areas and populations are defined and in methodological analysis. METHODS: We linked data for veterans (n = 37,466) who attended the VA Pittsburgh Healthcare System to 2000 United States Census and the US Department of Agriculture's Economic Research Service data. RESULTS: The RUCA and the IRRZIP do not consistently classify the same ZIP code areas and populations as rural. Using the IRRZIP, each 10th increment in increased rurality was associated with a 2.6 increased odds of receiving primary care at a satellite clinic. CONCLUSIONS: The IRRZIP is a straightforward measure that is easy to use and interpret and may be a relevant alternative rural classification system that can be used in health services research. |
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| AbstractList | BACKGROUNDAccurate analysis of health problems facing rural residents depends on how rurality is defined. Health services research relies frequently on the rural urban commuting area (RUCA) codes to estimate rurality at the small area level. We modified the county-level Index of Relative Rurality (IRR) to the ZIP code level (IRRZIP ) to create an alternative small-area-level rural classification system. We then compared how the 2 rural classification systems differ in how rural areas and populations are defined and in methodological analysis.METHODSWe linked data for veterans (n = 37,466) who attended the VA Pittsburgh Healthcare System to 2000 United States Census and the US Department of Agriculture's Economic Research Service data.RESULTSThe RUCA and the IRRZIP do not consistently classify the same ZIP code areas and populations as rural. Using the IRRZIP , each 10th increment in increased rurality was associated with a 2.6 increased odds of receiving primary care at a satellite clinic.CONCLUSIONSThe IRRZIP is a straightforward measure that is easy to use and interpret and may be a relevant alternative rural classification system that can be used in health services research. Background Accurate analysis of health problems facing rural residents depends on how rurality is defined. Health services research relies frequently on the rural urban commuting area (RUCA) codes to estimate rurality at the small area level. We modified the county‐level Index of Relative Rurality (IRR) to the ZIP code level (IRRZIP) to create an alternative small‐area‐level rural classification system. We then compared how the 2 rural classification systems differ in how rural areas and populations are defined and in methodological analysis. Methods We linked data for veterans (n = 37,466) who attended the VA Pittsburgh Healthcare System to 2000 United States Census and the US Department of Agriculture's Economic Research Service data. Results The RUCA and the IRRZIP do not consistently classify the same ZIP code areas and populations as rural. Using the IRRZIP, each 10th increment in increased rurality was associated with a 2.6 increased odds of receiving primary care at a satellite clinic. Conclusions The IRRZIP is a straightforward measure that is easy to use and interpret and may be a relevant alternative rural classification system that can be used in health services research. Accurate analysis of health problems facing rural residents depends on how rurality is defined. Health services research relies frequently on the rural urban commuting area (RUCA) codes to estimate rurality at the small area level. We modified the county-level Index of Relative Rurality (IRR) to the ZIP code level (IRRZIP ) to create an alternative small-area-level rural classification system. We then compared how the 2 rural classification systems differ in how rural areas and populations are defined and in methodological analysis. We linked data for veterans (n = 37,466) who attended the VA Pittsburgh Healthcare System to 2000 United States Census and the US Department of Agriculture's Economic Research Service data. The RUCA and the IRRZIP do not consistently classify the same ZIP code areas and populations as rural. Using the IRRZIP , each 10th increment in increased rurality was associated with a 2.6 increased odds of receiving primary care at a satellite clinic. The IRRZIP is a straightforward measure that is easy to use and interpret and may be a relevant alternative rural classification system that can be used in health services research. Background Accurate analysis of health problems facing rural residents depends on how rurality is defined. Health services research relies frequently on the rural urban commuting area (RUCA) codes to estimate rurality at the small area level. We modified the county-level Index of Relative Rurality (IRR) to the ZIP code level (IRR sub(ZIP)) to create an alternative small-area-level rural classification system. We then compared how the 2 rural classification systems differ in how rural areas and populations are defined and in methodological analysis. Methods We linked data for veterans (n = 37,466) who attended the VA Pittsburgh Healthcare System to 2000 United States Census and the US Department of Agriculture's Economic Research Service data. Results The RUCA and the IRR sub(ZIP) do not consistently classify the same ZIP code areas and populations as rural. Using the IRR sub(ZIP), each 10th increment in increased rurality was associated with a 2.6 increased odds of receiving primary care at a satellite clinic. Conclusions The IRR sub(ZIP) is a straightforward measure that is easy to use and interpret and may be a relevant alternative rural classification system that can be used in health services research. Background Accurate analysis of health problems facing rural residents depends on how rurality is defined. Health services research relies frequently on the rural urban commuting area (RUCA) codes to estimate rurality at the small area level. We modified the county-level Index of Relative Rurality (IRR) to the ZIP code level (IRRZIP) to create an alternative small-area-level rural classification system. We then compared how the 2 rural classification systems differ in how rural areas and populations are defined and in methodological analysis. Methods We linked data for veterans (n = 37,466) who attended the VA Pittsburgh Healthcare System to 2000 United States Census and the US Department of Agriculture's Economic Research Service data. Results The RUCA and the IRRZIP do not consistently classify the same ZIP code areas and populations as rural. Using the IRRZIP, each 10th increment in increased rurality was associated with a 2.6 increased odds of receiving primary care at a satellite clinic. Conclusions The IRRZIP is a straightforward measure that is easy to use and interpret and may be a relevant alternative rural classification system that can be used in health services research. |
| Author | Inagami, Sanae Stone, Roslyn A. Shendge, Martine M. Gao, Shasha Karimi, Hassan Probst, Janice C. |
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| Keywords | index of relative rurality health services research rural classification observational data geography |
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| Notes | http://dx.doi.org/10.1111/jrh.12148 Department of Veterans Affairs - No. 72-047 Appendix AAppendix B ArticleID:JRH12148 istex:C5DDA3B6786AC41F3E311CCFA71ED01C498F0A37 ark:/67375/WNG-5SJCHJNZ-Q Acknowledgments Support for this paper was provided by Locally Initiated Project 72‐047 from the Department of Veterans Affairs. Funding We thank Michael Fine, Mary Walsh and staff at CHERP for their support. We thank Alan West, Deborah Seltzer, and Judith Lave for help with revisions. We thank Brigitte Waldorff for providing analytical support. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
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| References_xml | – year: 2011 – volume: 95 start-page: 1149 year: 2005 end-page: 1155 article-title: Rural definitions for health policy and research publication-title: Am J Public Health – volume: 41 start-page: 79 year: 2006 end-page: 102 article-title: How adults’ access to outpatient physician services relates to the local supply of primary care physicians in the rural southeast publication-title: Health Res Educ Trust – year: 2011 article-title: Rural definitions: data documentation and methods publication-title: USDA, Economic Research Service – start-page: 392 year: 1967 end-page: 394 – volume: 83 start-page: 162 year: 2006 end-page: 175 article-title: Defining urban and rural areas in U.S. epidemiologic studies publication-title: J Urban Health – volume: 22 start-page: 140 issue: 2 year: 2006 end-page: 146 article-title: Geographic access to health care for rural Medicare beneficiaries publication-title: J Rural Health – volume: 20 start-page: 727 year: 1999 end-page: 748 article-title: Metropolitan, urban, and rural commuting areas: toward a better depiction of the U.S. settlement system publication-title: Urban Geogr – year: 2006 – year: 2003 – volume: 2005 start-page: 465 year: 2005 end-page: 499 article-title: In the national interest: defining rural and urban correctly in research and public policy publication-title: Int Reg Sci Rev – start-page: 11 year: 1998 end-page: 22 – volume: 11 start-page: 31 year: 1996 end-page: 39 article-title: Census tracts more precisely define rural populations and areas publication-title: Rural Dev Perspect – year: 1998 – ident: e_1_2_7_16_1 – start-page: 11 volume-title: Tenth Report: Physician Distribution and Health Care Challenges in Rural and Inner‐City Areas year: 1998 ident: e_1_2_7_12_1 contributor: fullname: Council on Graduate Medical Education – ident: e_1_2_7_2_1 doi: 10.1177/0160017605279000 – ident: e_1_2_7_3_1 doi: 10.1007/s11524-005-9016-3 – ident: e_1_2_7_8_1 doi: 10.2747/0272-3638.20.8.727 – volume-title: Definitions of Rural: A Handbook for Health Policy Makers and Researchers year: 1998 ident: e_1_2_7_5_1 contributor: fullname: Ricketts TC – ident: e_1_2_7_11_1 doi: 10.1111/j.1748-0361.2006.00022.x – ident: e_1_2_7_6_1 – ident: e_1_2_7_17_1 – volume: 41 start-page: 79 year: 2006 ident: e_1_2_7_13_1 article-title: How adults’ access to outpatient physician services relates to the local supply of primary care physicians in the rural southeast publication-title: Health Res Educ Trust contributor: fullname: Pathman DE – ident: e_1_2_7_4_1 doi: 10.2105/AJPH.2004.042432 – ident: e_1_2_7_9_1 – volume-title: The Statistical Evaluation of Medical Tests for Classification and Prediction year: 2003 ident: e_1_2_7_15_1 contributor: fullname: Pepe MS – volume: 11 start-page: 31 year: 1996 ident: e_1_2_7_7_1 article-title: Census tracts more precisely define rural populations and areas publication-title: Rural Dev Perspect contributor: fullname: Cromartie J – start-page: 392 volume-title: Handbook of Methods of Applied Statistics, Volume I year: 1967 ident: e_1_2_7_14_1 contributor: fullname: Chakravarti IM – volume-title: A Continuous Multi‐Dimensional Measure of Rurality: Moving Beyond Threshold Measures year: 2006 ident: e_1_2_7_10_1 contributor: fullname: Waldorf BS |
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| Title | Adapting the Index of Relative Rurality (IRR) to Estimate Rurality at the ZIP Code Level: A Rural Classification System in Health Services Research |
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