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      A cross-sectional study on health differences between rural and non-rural U.S. counties using the County Health Rankings

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          Abstract

          Background

          By examining 2013 County Health Rankings and Roadmaps data from the University of Wisconsin and the Robert Wood Johnson Foundation, this paper seeks to add to the available literature on health variances between United States residents living in rural and non-rural areas. We believe this is the first study to use the Rankings data to measure rural and urban health differences across the United States and therefore highlights the national need to address shortfalls in rural healthcare and overall health. The data indicates that U.S. residents living in rural counties are generally in poorer health than their urban counterparts.

          Methods

          We used 2013 County Health Rankings data to evaluate differences across the six domains of interest (mortality, morbidity, health behaviors, clinical care, social and economic factors, and physical environment) for rural and non-rural U.S. counties. This is a cross-sectional study employing chi-square analysis and logit regression.

          Results

          We found that residents living in rural U.S. counties are more likely to have poorer health outcomes along a variety of measurements that comprise the County Health Rankings’ indexed domains of health quality. These populations have statistically significantly (p ≤ 0.05) lower scores in such areas as health behavior, morbidity factors, clinical care, and the physical environment. We attribute the differences to a variety of factors including limitations in infrastructure, socioeconomic differences, insurance coverage deficiencies, and higher rates of traffic fatalities and accidents.

          Discussions

          The largest differences between rural and non-rural counties were in the indexed domains of mortality and clinical care.

          Conclusions

          Our analysis revealed differences in health outcomes in the County Health Rankings’ indexed domains between rural and non-rural U.S. counties. We also describe limitations and offer commentary on the need for more uniform measurements in the classification of the terms rural and non-rural. These results can influence practitioners and policy makers in guiding future research and when deciding on funding allocation.

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          Most cited references43

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          Prevalence of obesity among adults from rural and urban areas of the United States: findings from NHANES (2005-2008).

          Rural residents have higher rates of chronic diseases compared to their urban counterparts, and obesity may be a major contributor to this disparity. This study is the first analysis of obesity prevalence in rural and urban adults using body mass index classification with measured height and weight. In addition, demographic, diet, and physical activity correlates of obesity across rural and urban residence are examined. Analysis of body mass index (BMI), diet, and physical activity from 7,325 urban and 1,490 rural adults in the 2005-2008 National Health and Nutrition Examination Survey (NHANES). The obesity prevalence was 39.6% (SE = 1.5) among rural adults compared to 33.4% (SE = 1.1) among urban adults (P = .006). Prevalence of obesity remained significantly higher among rural compared to urban adults controlling for demographic, diet, and physical activity variables (odds ratio = 1.18, P = .03). Race/ethnicity and percent kcal from fat were significant correlates of obesity among both rural and urban adults. Being married was associated with obesity only among rural residents, whereas older age, less education, and being inactive was associated with obesity only among urban residents. Obesity is markedly higher among adults from rural versus urban areas of the United States, with estimates that are much higher than the rates suggested by studies with self-reported data. Obesity deserves greater attention in rural America. © 2012 National Rural Health Association.
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            The importance of place of residence: examining health in rural and nonrural areas.

            We examined differences in health measures among rural, suburban, and urban residents and factors that contribute to these differences. Whereas differences between rural and urban residents were observed for some health measures, a consistent rural-to-urban gradient was not always found. Often, the most rural and the most urban areas were found to be disadvantaged compared with suburban areas. If health disparities are to be successfully addressed, the relationship between place of residence and health must be understood.
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              National Patterns in Environmental Injustice and Inequality: Outdoor NO2 Air Pollution in the United States

              We describe spatial patterns in environmental injustice and inequality for residential outdoor nitrogen dioxide (NO2) concentrations in the contiguous United States. Our approach employs Census demographic data and a recently published high-resolution dataset of outdoor NO2 concentrations. Nationally, population-weighted mean NO2 concentrations are 4.6 ppb (38%, p 2.5 hours/week of physical activity). Inequality for NO2 concentration is greater than inequality for income (Atkinson Index: 0.11 versus 0.08). Low-income nonwhite young children and elderly people are disproportionately exposed to residential outdoor NO2. Our findings establish a national context for previous work that has documented air pollution environmental injustice and inequality within individual US metropolitan areas and regions. Results given here can aid policy-makers in identifying locations with high environmental injustice and inequality. For example, states with both high injustice and high inequality (top quintile) for outdoor residential NO2 include New York, Michigan, and Wisconsin.
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                Author and article information

                Contributors
                tanderson@eirh.org
                Dsaman@eirh.org
                mlipsky@roseman.edu
                nlutfiyy@umn.edu
                Journal
                BMC Health Serv Res
                BMC Health Serv Res
                BMC Health Services Research
                BioMed Central (London )
                1472-6963
                1 October 2015
                1 October 2015
                2015
                : 15
                : 441
                Affiliations
                [ ]Essentia Institute of Rural Health, 502 E. 2nd Street, Duluth, MN 55805 USA
                [ ]National Center for Interprofessional Practice and Education, University of Minnesota-Twin Cities Campus, MMC 501 Mayo, 420 Delaware St SE, Minneapolis, MN 55455 USA
                [ ]Roseman University of Health Sciences, 10920 S. River Front Parkway, South Jordan, UT 84095 USA
                Article
                1053
                10.1186/s12913-015-1053-3
                4590732
                26423746
                77ba3e82-13c3-4524-80db-f9c79752f84e
                © Anderson et al. 2015

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 19 November 2014
                : 11 September 2015
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2015

                Health & Social care
                rural health,health outcomes,rurality,county health rankings
                Health & Social care
                rural health, health outcomes, rurality, county health rankings

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