Health Disparities
Differences in Health Outcomes and Health Factor Domains of the 2020 County Health Rankings Across Urban-Rural-Frontier Counties in the United States Brody Gibson, BS* Brody Gibson Gibson Gibson Gibson Gibson Gibson University of Utah – Huntsman Cancer Institute
Urban-rural health disparities are well documented, yet variation by degree of rurality and remoteness remains poorly understood. This study examines county-level population health using the 2020 County Health Rankings, which summarize standardized domains of health outcomes (Length of Life and Quality of Life) and health factors (Health Behaviors, Clinical Care, Social and Economic Factors, and Physical Environment). We assessed these domains across one urban (metropolitan) and four rural groups—micropolitan, frontier-micropolitan, noncore, and frontier-noncore—using Integrated Metropolitan-to-Frontier Area Codes (IMFAC). We summarized the proportion of counties by domain quartiles and IMFAC category, and estimated odds ratios of being in the most disadvantaged (Q4) for each rural group relative to urban using logistic regression with state fixed effects. Proportions of counties in Q4 increased with rurality and remoteness for Length of Life, Quality of Life, Clinical Care, and Social and Economic Factors, while Health Behaviors showed greater disadvantage in micropolitan and frontier-micropolitan counties. The odds of Q4 ranking for Length of Life increased from micropolitan (OR=2.16; 95%CI:1.64–2.84) to frontier-noncore (OR=4.05; 95%CI:3.06–5.37) relative to urban counties. Clinical Care showed the largest rural disadvantage, with noncore (OR=4.40; 95%CI:3.47–5.58) and frontier-noncore counties (OR=7.40; 95%CI:5.55–9.88) at increased odds of greater disadvantage. For Quality of Life, all rural subgroups had higher odds of being in Q4, greatest in frontier-micropolitan (OR=3.03; 95% CI:2.07–4.41) and frontier-noncore counties (OR=3.53; 95%CI:2.67–4.66). Physical Environment showed an inverse pattern, with rural counties at lower odds of disadvantage than urban, particularly frontier-noncore counties (OR=0.09; 95%CI:0.06–0.13). These findings show that rural health disadvantage is not uniform and that broad urban-rural comparisons may mask important differences.