Coding Schemas for Rural-Urban Designations with New York State Counties and Birth Outcomes as Exemplars

Nursing is integral to the attainment of better health outcomes through advocacy and policy recommendation at federal, state, and local levels. Accurate measures of rurality should be applied at the decision making level for the allocation of scarce resources that support projects and programs most effective for vulnerable rural populations. Maintaining policies that benefit vulnerable populations requires funding; but needs analyses using inappropriate coding schemas can result in lack of funding or the implementation of policies that are ineffective for the targeted population.

The purposes of this study are to provide background information on the agencies responsible for the development of rural coding schemas at the county level, to explain the types of codes and the definitions of terms included in the codes, and to provide a concise table that presents the assigned codes for each county in New York State as an exemplar.

This study attempted to elucidate nuances among the three rural coding schemas and demonstrated that using the appropriate rural coding schema may highlight rural/urban health disparities more clearly.

Although highly correlated, the different schemes classify counties in conjunction with the purposes for which they were developed. There remain important differences among them. Based on the choice of classification scheme, these differences can result in totally different conclusions for research, potentially affecting decisions for policy formulation and implementation.