Constructing the 2013 NCHS Urban-Rural Classification Scheme for Counties: A tool for examining health in rural and nonrural areas

Urbanization level of place of residence has long been associated with differences in health outcomes, health behaviors, and health care access and utilization. Identifying these urban-rural health differences is important now and will be even more important in assessing the effects of the Affordable Care Act. This talk will describe construction and validation of the 2013 NCHS Urban-Rural Classification Scheme for Counties. The NCHS scheme was developed specifically for use in studying urban-rural differences in health measures. It has four levels for metropolitan counties (large central metro, large fringe metro, medium metro, and small metro) and two for nonmetropolitan counties (micropolitan and noncore). An important distinguishing feature of the NCHS scheme is its distinction between suburban and central counties of the largest metropolitan areas. Failure to separate these two types of counties can mask important health differences because: 1) residents of suburban counties tend to fare better than residents of central counties and better than residents of other urbanization levels, and 2) residents of central counties tend to fare worse than residents of suburban and smaller metro areas. The 2013 NCHS scheme, an update of the 2006 NCHS scheme; incorporates the 2013 delineation of metropolitan and micropolitan statistical areas and 2010 census data. The usefulness of the NCHS scheme for identifying urban-rural health differences will be illustrated using health measures from the National Health Interview Survey and National Vital Statistics System. Analytic issues encountered when using urban-rural schemes will be discussed.