Concordance of Rural‐Urban Self‐identity and ZIP Code‐Derived Rural‐Urban Commuting Area (RUCA) Designation

Abstract

Purpose This study examined the concordance between individuals’ self‐reported rural‐urban category of their community and ZIP Code‐derived Rural‐Urban Commuting Area (RUCA) category. Methods An Internet‐based survey, administered from August 2017 through November 2017, was used to collect participants’ sociodemographic characteristics, self‐reported ZIP Code of residence, and perception of which RUCA category best describes the community in which they live. We calculated weighted kappa (ĸ) coefficients (95% confidence interval [CI]) to test for concordance between participants’ ZIP Code‐derived RUCA category and their selection of RUCA descriptor. Descriptive frequency distributions of participants' demographics are presented. Findings A total of 622 survey participants, residents of New Hampshire (63%) and Vermont (37%), responded to the survey's self‐reported rural‐urban category. The overall ĸ was 0.33 (95% CI: 0.27‐0.38). The highest concordance was found among those living in a small rural area (N = 81, 13%): 62% of this group identified their communities as small rural. Sixty‐five percent (300/459) of participants residing in urban or large rural areas reported their community as more rural (small rural or isolated). Sixty‐eight percent (111/163) of participants living in small rural or isolated areas identified their community as more urban (large rural or urban). Conclusions Discordance was found between self‐report of rural‐urban category and ZIP Code‐derived RUCA designation. Caution is warranted when attributing rural‐urban designation to individuals based on geographic unit, since perceived rurality/urbanicity of their community that relates to health behaviors may not be reflected.

Refining a traditional urban-rural classification approach to better assess heterogeneity of treatment effects in patient-centered outcomes research

“…Even though most of our initially classified “rural” sites are located in and primarily serve “urban” ZIP codes according to the RUCA categorization, the people living in these areas report that they live in rural areas. This is consistent with recent research that demonstrates extremely poor concordance between rural-urban self-identification and RUCA designation [16] . Further, these areas associated with self-identified “rural” clinic sites have low population density, lack public bus service, are highly agricultural, and, with the exception of Jackson (population 67,005), they lack major urban nuclei with greater than 50,000 people [17] .…”

Self-reported vs RUCA rural-urban classification among North Carolina pharmacists

“…found significant differences between physicians’ self-reported workplace geographic classifications and census-based classification. 11 , 16 In pharmacy, studies examining service availability and rural-urban differences have used various definitions of rurality. 14 , 17 - 21 In a systematic review, Howarth et al .…”

Physician Practice Location

“…ZIP code analyses are frequently used by state and federal agencies in delineating areas by their demographic, socioeconomic, cultural, and environmental characteristics. 23 ZIP codes have often been used to create taxonomies such as the Rural-Urban Commuting Area Codes (RUCAs) for delineating rural and urban areas. 24 State medical licensure boards offer another source of physician location ZIP code data that may be higher in accuracy and validity, though few studies have compared licensure location data to other datasets.…”