NDLI: Reconsidering the Rural–Urban Continuum in Rural Health Research: A Test of Stable Relationships Using Mortality as a Health Measure

Content Provider	Springer Nature Link
Author	Cossman, Ronald E. Cossman, Jeralynn S. Cosby, Arthur G. Reavis, Rebel M.
Copyright Year	2008
Abstract	Health researchers commonly use existing rural–urban continua based on population size and adjacency to metro areas to categorize counties. When these continua are collapsed into simple rural-versus-urban aggregations, significant differences within the categories are masked. We show that when the entire range of the 10-category Rural–Urban Continuum Codes (RUCC) is used, the direction of the coefficients may differ and the fit of the model varies substantially across contiguous categories. However, collapsing contiguous categories masks variations within the continuum. To the extent that health policy decisions are made based on such aggregations, inappropriate policy choices may result (e.g., low payments to counties with relatively high needs). Given Congressional calls to address rural health, and the new Office of Management and Budget (OMB) statistical area classification system, debate over appropriate categorizations schemes is timely. We regress age-adjusted all-causes of death on various socioeconomic factors to assess the appropriate use of variants of the rural–urban continuum for health research. Our findings support two main conclusions. First, researchers collapsing urban–rural categorization schemes may be masking important categorical differences, inadvertently influencing policymaking predicated on their work. Second, finer classification of settlements yields uneven results. That is, coefficients shift signs across the continuum, indicating that collapsed models may be inappropriate. Results derived using collapsed variants of the RUCC may be too unstable to use as health research and funding categorization schemes. We suggest that a health status or outcomes categorization scheme is likely to be a more appropriate metric for rural health research.
Starting Page	459
Ending Page	476
Page Count	18
File Format	PDF
ISSN	01675923
Journal	Population Research and Policy Review
Volume Number	27
Issue Number	4
e-ISSN	15737829
Language	English
Publisher	Springer Netherlands
Publisher Date	2008-02-02
Publisher Place	Dordrecht
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Rural–urban continuum Health policy Mortality Inequality Research methods Population Economics Sociology Demography
Content Type	Text
Resource Type	Article
Subject	Demography Management, Monitoring, Policy and Law

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1	Ministry of Education (GoI), Department of Higher Education	Sanctioning Authority	https://www.education.gov.in/ict-initiatives
2	Indian Institute of Technology Kharagpur	Host Institute of the Project: The host institute of the project is responsible for providing infrastructure support and hosting the project	https://www.iitkgp.ac.in
3	National Digital Library of India Office, Indian Institute of Technology Kharagpur	The administrative and infrastructural headquarters of the project	Dr. B. Sutradhar bsutra@ndl.gov.in
4	Project PI / Joint PI	Principal Investigator and Joint Principal Investigators of the project	Dr. B. Sutradhar bsutra@ndl.gov.in Prof. Saswat Chakrabarti will be added soon
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