Rural-urban disparities in health outcomes, clinical care, health behaviors, and social determinants of health and an action-oriented, dynamic tool for visualizing them

William B. Weeks; Ji E. Chang; José A. Pagán; Jeffrey Lumpkin; Divya Michael; Santiago Salcido; Allen Kim; Peter Speyer; Ann Aerts; James N. Weinstein; Juan M. Lavista

doi:10.1371/journal.pgph.0002420

journal article Open Access Oct 03, 2023

Rural-urban disparities in health outcomes, clinical care, health behaviors, and social determinants of health and an action-oriented, dynamic tool for visualizing them

William B. Weeks Ji E. Chang José A. Pagán

Jeffrey Lumpkin Divya Michael Santiago Salcido

Allen Kim Peter Speyer Ann Aerts James N. Weinstein Juan M. Lavista

PLOS Global Public Health Vol. 3 No. 10 pp. e0002420 · Public Library of Science (PLoS)

View at Publisher Save 10.1371/journal.pgph.0002420

Abstract

While rural-urban disparities in health and health outcomes have been demonstrated, because of their impact on (and intervenability to improve) health and health outcomes, we sought to examine cross-sectional and longitudinal inequities in health, clinical care, health behaviors, and social determinants of health (SDOH) between rural and non-rural counties in the pre-pandemic era (2015 to 2019), and to present a Health Equity Dashboard that can be used by policymakers and researchers to facilitate examining such disparities. Therefore, using data obtained from 2015–2022 County Health Rankings datasets, we used analysis of variance to examine differences in 33 county level attributes between rural and non-rural counties, calculated the change in values for each measure between 2015 and 2019, determined whether rural-urban disparities had widened, and used those data to create a Health Equity Dashboard that displays county-level individual measures or compilations of them. We followed STROBE guidelines in writing the manuscript. We found that rural counties overwhelmingly had worse measures of SDOH at the county level. With few exceptions, the measures we examined were getting worse between 2015 and 2019 in all counties, relatively more so in rural counties, resulting in the widening of rural-urban disparities in these measures. When rural-urban gaps narrowed, it tended to be in measures wherein rural counties were outperforming urban ones in the earlier period. In conclusion, our findings highlight the need for policymakers to prioritize rural settings for interventions designed to improve health outcomes, likely through improving health behaviors, clinical care, social and environmental factors, and physical environment attributes. Visualization tools can help guide policymakers and researchers with grounded information, communicate necessary data to engage relevant stakeholders, and track SDOH changes and health outcomes over time.

Topics

No keywords indexed for this article. Browse by subject →

References

37

[1]

Rural-Urban Disparity in Mortality in the US From 1999 to 2019

Sarah H. Cross, Robert M. Califf, HAIDER J. WARRAICH

JAMA 2021 10.1001/jama.2021.5334

[2]

B.H. Walker "Trends in lifespan variation across the spectrum of rural and urban places in the United States, 1990–2017" SSM Popul Health (2022) 10.1016/j.ssmph.2022.101213

[3]

E. Loccoh "Rural-Urban Disparities In All-Cause Mortality Among Low-Income Medicare Beneficiaries, 2004–17." Health Aff (Millwood), (2021) 10.1377/hlthaff.2020.00420

[4]

Growth and Persistence of Place-Based Mortality in the United States: The Rural Mortality Penalty

Arthur G. Cosby, M. Maya McDoom-Echebiri, Wesley James et al.

American Journal of Public Health 2019 10.2105/ajph.2018.304787

[5]

M.C. Garcia "Reducing Potentially Excess Deaths from the Five Leading Causes of Death in the Rural United States" MMWR Surveill Summ (2017) 10.15585/mmwr.ss6602a1

[6]

D.B. Ehrenthal "Infant Mortality in Rural and Nonrural Counties in the United States" Pediatrics (2020) 10.1542/peds.2020-0464

[7]

H. Son "Social Determinants of Cardiovascular Health: A Longitudinal Analysis of Cardiovascular Disease Mortality in US Counties From 2009 to 2018" J Am Heart Assoc (2023) 10.1161/jaha.122.026940

[8]

S.S. Khan "Association between county-level risk groups and COVID-19 outcomes in the United States: a socioecological study" BMC Public Health (2022) 10.1186/s12889-021-12469-y

[9]

A.S. Long "Socioeconomic variables explain rural disparities in US mortality rates: Implications for rural health research and policy" SSM Popul Health (2018) 10.1016/j.ssmph.2018.08.009

[10]

J.C. Spencer "Decomposing Mortality Disparities in Urban and Rural U.S. Counties." Health Serv Res (2018) 10.1111/1475-6773.12982

[11]

D.C. Rhubart "Self-Rated Physical Health Among Working-Aged Adults Along the Rural-Urban Continuum—United States, 2021" MMWR Morb Mortal Wkly Rep (2022) 10.15585/mmwr.mm7105a1

[12]

Comparing Preventable Acute Care Use of Rural Versus Urban Americans: an Observational Study of National Rates During 2008–2017

Kenton J. Johnston, Hefei Wen, Ameya Kotwal et al.

Journal of General Internal Medicine 2021 10.1007/s11606-020-06532-4

[13]

S.S. Kurani "Association of Neighborhood Measures of Social Determinants of Health With Breast, Cervical, and Colorectal Cancer Screening Rates in the US Midwest" JAMA Netw Open (2020) 10.1001/jamanetworkopen.2020.0618

[14]

L. Skinner "Rethinking rurality: using hospital referral regions to investigate rural-urban health outcomes" BMC Health Serv Res (2022) 10.1186/s12913-022-08649-0

[15]

Social determinants of health. Available at https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1. [Accessed 2023 April 11].

[16]

S. Artiga "Beyond Health Care: The Role of Social Determinants in Pomoting Health and Health Equity."

[17]

G.K. Singh "Social Determinants of Health in the United States: Addressing Major Health Inequality Trends for the Nation, 1935–2016" Int J MCH AIDS (2017) 10.21106/ijma.236

[18]

J.N. Weinstein (2017) 10.17226/24624

[19]

The Biden-⁠Harris Administration Immediate Priorities. Available at https://www.whitehouse.gov/priorities. [Accessed 2023 February 24].

[20]

Health in All Policies "Centers for Disease Control and Prevention, Office of the Associate Director for Policy and Strategy" (2016)

[21]

R. Butkus "Envisioning a Better U.S. Health Care System for All: Reducing Barriers to Care and Addressing Social Determinants of Health" Ann Intern Med (2020) 10.7326/m19-2410

[22]

T.J. Anderson "A cross-sectional study on health differences between rural and non-rural U.S. counties using the County Health Rankings." BMC Health Serv Res (2015) 10.1186/s12913-015-1053-3

[23]

C. Henning-Smith "Rural-Urban Differences in Medicare Quality Outcomes and the Impact of Risk Adjustment" Med Care (2017) 10.1097/mlr.0000000000000761

[24]

County Health Rankings & Roadmaps, Ranked and Additional Measures, Data Sources, and Years. https://www.countyhealthrankings.org/explore-health-rankings/county-health-rankings-measures. [Accessed 2023 February 8].

[25]

NCHS Urban-Rural Classification Scheme for Counties, 2013. https://www.cdc.gov/nchs/data_access/urban_rural.htm. 2013 [cited 2023 January 6].

[26]

Rural-Urban Continuum Codes. (Available at https://catalog.data.gov/dataset/rural-urban-continuum-codes#:~:text=The%202013%20Rural-Urban%20Continuum%20Codes%20form%20a%20classification,of%20urbanization%20and%20adjacency%20to%20a%20metro%20area.). 2018. [Accessed 2023 April 17].

[27]

Which Definition of Rurality Should I Use?

Julianna C. Long, Paul L. Delamater, George M. Holmes

Medical Care 2021 10.1097/mlr.0000000000001612

[28]

C. Gessert "Rural definition of health: a systematic literature review" BMC Public Health (2015) 10.1186/s12889-015-1658-9

[29]

C.E. Johnson-Agbakwu "Racism, COVID-19, and Health Inequity in the USA: a Call to Action." J Racial Ethn Health Disparities (2022) 10.1007/s40615-020-00928-y

[30]

Y.J. Cheng "Prevalence of Diabetes by Race and Ethnicity in the United States, 2011–2016" JAMA (2019) 10.1001/jama.2019.19365

[31]

"Life expectancy by county, race, and ethnicity in the USA, 2000–19: a systematic analysis of health disparities" Lancet (2022) 10.1016/s0140-6736(22)00876-5

[32]

J.A. Martin "Births: Final Data for 2018" Natl Vital Stat Rep (2019)

[33]

A.S. Venkataramani "Economic opportunity, health behaviours, and health outcomes in the USA: a population-based cross-sectional study" Lancet Public Health (2016) 10.1016/s2468-2667(16)30005-6

[34]

R.C. Brownson "Fostering more-effective public health by identifying administrative evidence-based practices: a review of the literature" Am J Prev Med (2012) 10.1016/j.amepre.2012.06.006

[35]

Transforming the communication between citizens and government through AI-guided chatbots

Aggeliki Androutsopoulou, Nikos Karacapilidis, Euripidis Loukis et al.

Government Information Quarterly 2019 10.1016/j.giq.2018.10.001

[36]

A. Lundkvist "Policy-makers’ views on translating burden of disease estimates in health policies: bridging the gap through data visualization" Arch Public Health (2021) 10.1186/s13690-021-00537-z

[37]

W.B. Weeks "Economic Prosperity and Cardiovascular Mortality: Further Evidence That All Policy Is Health Policy" JAMA (2021) 10.1001/jama.2020.26717

Cited By

128

The Next Frontiers in Preventive and Personalized Healthcare: Artificial Intelligent-powered Solutions

Rasit Dinc, Nurittin Ardic · 2025

Journal of Preventive Medicine and...

Metrics

128

Citations

37

References

Details

Published: Oct 03, 2023
Vol/Issue: 3(10)
Pages: e0002420
License: View

Authors

Department of Public Health Policy and Management, School of Global Public Health, New York University, New York

Cite This Article

William B. Weeks, Ji E. Chang, José A. Pagán, et al. (2023). Rural-urban disparities in health outcomes, clinical care, health behaviors, and social determinants of health and an action-oriented, dynamic tool for visualizing them. PLOS Global Public Health, 3(10), e0002420. https://doi.org/10.1371/journal.pgph.0002420

Rural-urban disparities in health outcomes, clinical care, health behaviors, and social determinants of health and an action-oriented, dynamic tool for visualizing them

You May Also Like