Identifying Urban-Rural Health Disparities

The National Center for Health Statistics (NCHS) Urban-Rural Classification Scheme for counties is an urban-rural taxonomy specifically designed for assessing and monitoring health differences across the full urbanization continuum. The classification categorizes U.S. counties and county equivalents into six levels (four metropolitan, two nonmetropolitan). A key feature of the NCHS classification is its ability to differentiate the “inner cities” and “suburbs” of large metropolitan areas – residents of suburban areas tend to fare substantially better on many health measures than residents of other urbanization levels. The usefulness of the NCHS taxonomy is demonstrated using mortality data and health measures from NCHS surveys. Analytic issues that arise when studying urban-rural disparities over time are noted. Options for modifying the NCHS taxonomy when it is updated to reflect the 2010 census are examined.