The Utility of Rural and Underserved Designations in Geospatial Assessments of Distance Traveled to Healthcare Services: Implications for Public Health Research and Practice

Health disparities research in rural populations is based on several common taxonomies identified by geography and population density. However, little is known about the implications of different rurality definitions on public health outcomes. To help illuminate the meaning of different rural designations often used in research, service delivery, or policy reports, this study will (1) review the different definitions of rurality and their purposes; (2) identify the overlap of various rural designations in an eight-county Brazos Valley region in Central Texas; (3) describe participant characteristic profiles based on distances traveled to obtain healthcare services; and (4) examine common profile characteristics associated with each designation. Data were analyzed from a random sample from 1,958 Texas adults participating in a community assessment. K-means cluster analysis was used to identify natural groupings of individuals based on distance traveled to obtain three healthcare services: medical care, dental care, and prescription medication pick-up. Significant variation in cluster representation and resident characteristics was observed by rural designation. Given widely used taxonomies for designating areas as rural (or provider shortage) in health-related research, this study highlights differences that could influence research results and subsequent program and policy development based on rural designation. 1. Introduction According to the United States Census, in 2010, there were approximately 60 million adults or 20% of the population living in rural areas [1]. Rural areas have been characterized by well-documented health disparities in terms of healthcare access and health outcomes [2–5]. Distance to health care is often attributed as a barrier to obtaining needed healthcare [6]. Additionally, residents of rural communities are more likely to have higher rates of poverty, poorer educational attainment, and unique health issues such as morbidity and mortality from agriculture, mining, forestry, and fishing [4]. Given the diversity of rural settings within and across different states and regional areas, it is difficult to generalize health risks and access to care in these diverse populations. Public health researchers, practitioners, and policy-makers often use underserved and rural interchangeably when referring to areas with low population density, but to what extent do these two terms carry similar meaning? Our current understanding of rurality and rural designations is based largely on research using one of several common taxonomies related