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Use of RUCAs in Health Services Research
Gary Hart, PhD
Rural Health Research Center
Center for Health Workforce Studies
University of Washington
Seattle, Washington
Partners: Dick Morrill (UW) and John Cromartie (ERS)
Academy Health Annual Conference
Seattle, Washington
June 25, 2006
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Purpose
 Introduce Rural-Urban Commuting
Areas (RUCAs) (developed by our Rural
Health Research Center and ERS)
 Show Selected Examples
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RUCAs
RUCAs are a new Census tract-based
taxonomy that utilizes the standard
Census Bureau Urbanized Area and
Urban Cluster definitions in
combination with work commuting data
to characterize the nation’s Census
tracts regarding their rural and urban
status and functional relationships.
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RUCAs
RUCAs are a new Census tract-based
taxonomy that utilizes the standard
Census Bureau Urbanized Area and
Urban Cluster definitions in
combination with work commuting data
to characterize the nation’s Census
tracts regarding their rural and urban
status and functional relationships.
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RUCAs
A new Census tract-based taxonomy uses:
 standard Bureau of Census urbanized
area and place definitions
 functional relationships per work
commuting flows
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RUCAs
 New Version 2.0 now available
 Based on 2000 Census using 2004 ZIP
code areas (and 2004 population
estimates)
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Why RUCAs?
There is no “universal” rural definition
Concept of rural is nebulous at best
Most definitions are county-based
Provides sub county alternative
Takes functional relationships, population, &
population density into account
Taxonomy is adjustable to fit unique needs
Scheme allows better targeting
Taxonomy is ongoing, multi purpose, objective, &
rigorous
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But Why Care?
So we:
 do not miss research differences
 do not waste resources
 can target those in most need
 impartial empirical definition
 ultimately be more efficient and
improve the health of the population
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Intra Rural Important?
 Rural varies greatly from place to place
 Most rural folks receive most of care
within rural areas
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1
2
3
State Line
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6
4
5
State Line
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State Line
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9
7
8
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State Line
10
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State Line
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County Over
bounding
State Line
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County Under
bounding
State Line
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RUCA Codes X.X
1. Urban core Census tract
2. Census tract strongly tied to urban core
3. Census tract weakly tied to urban core
4. Large town Census tract
5. Census tract strongly tied to large town
6. Census tract weakly tied to large town
7. Small town Census tract
8. Census tract strongly tied to small town
9. Census tract weakly tied to small town
10. Isolated smaller rural Census tract
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Population by RUCA Codes
10
70.3
(2004 Population Estimates by ZIP Code Area)
9
8
7.3
Sub codes (.x) based on second
largest commuting flow.
Percent of Population
7
6
5.4
5
6,969,376
4
3
2.4
2.1
2
1.5
1.5
1.1
1
1.0
0.4 0.5
0.6
0.0
0.2 0.3 0.1
0.3
0.7 0.8
0.6 0.6
0.1
0.0 0.0 0.1 0.0
0.3
0.1 0.1
1.0
0.1 0.1 0.1
0
1.0 1.1 2.0 2.1 3.0 4.0 4.1 4.2 5.0 5.1 5.2 6.0 6.1 7.0 7.1 7.2 7.3 7.4 8.0 8.1 8.2 8.3 8.4 9.0 9.1 9.2 10.0 10.1 10.2 10.3 10.4 10.5 10.6
Note: Zeros are rounded to zero but contain population.
RUCA Codes
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Population by RUCA Codes
10
9
(2004 Population Estimates by ZIP Code Area)
70.3
8
Urban
7.3
Percent of Population
7
Large Rural
Small Rural
6
5.4
Isolated Small Rural
5
4
3
2.4
2.1
2
1.5
1.5
1.1
1
1.0
0.4 0.5
0.6
0.0
0.2 0.3 0.1
0.3
0.7 0.8
0.6 0.6
0.1
0.0 0.0 0.1 0.0
0.3
0.1 0.1
1.0
0.1 0.1 0.1
0
1.0 1.1 2.0 2.1 3.0 4.0 4.1 4.2 5.0 5.1 5.2 6.0 6.1 7.0 7.1 7.2 7.3 7.4 8.0 8.1 8.2 8.3 8.4 9.0 9.1 9.2 10.0 10.1 10.2 10.3 10.4 10.5 10.6
Note: Zeros are rounded to zero but contain population.
RUCA Codes
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Comparison of OMB (Metro/Non) and RUCA (Urban/Rural)
(2004 Population Estimates)
85
79.9
Rural can vary by 26%
75
RUCAs can be aggregated differently
65
Percent of Population
55
45
8,063,392
2,682,882
35
25
16.0
15
0.9
5
-5
Urban--Metro
Urban--Non Metro
3.2
Rural--Metro
Rural--Non Metro
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Comparison of OMB (Metro/Non) and RUCA (Urban/Rural)
(2004 Population Estimates)
85
79.9
75
Over 56 million rural residents
with this RUCA definition!
65
Percent of Population
55
45
35
25
16.0
15
0.9
5
-5
Urban--Metro
Urban--Non Metro
3.2
Rural--Metro
Rural--Non Metro
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Population by UIC and RUCA Category
(2005 AMA and AOA Data)
98
RUCA Categories :
92
93
Urban
Large Rural
Small Rural
Isolated Small Rural
90
82
77
76
75
Percent by RUCA Category
73
68
61
54
34
30
30
27
13
11
4
1
1 0
11
9
8
5
2
1
2
8
8
10
9
8
7
2
2
Urban Influence Codes (UICs) (County-Bas ed)
7
3
0
0
7
3
0
0
0
0 0
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RUCA Tools
Travel time & distance to Urbanized Areas and Large
Urban Clusters
Size of Urbanized Areas for 1s, 2s, and 3s
Size of Large Urban Clusters for 4/5/6s & 7/8/9s
Size of Urbanized Area or Urban Cluster associated with
largest secondary commuting flow
County identifier of largest population portion of each
ZIP code
Of course, other variables to be linked (e.g., poverty)
ALL THESE SHOULD BE ON OUR WEB SITE
WITHIN TWO WEEKS
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Examples of RUCA Uses




Federal programs: ORHP, CMS, OAT
National data sets: NSSRN, HCUP
Demography and ERS
Health-Related Research
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Patient Care Physicians by RUCA Categories
(2005 AMA and AOA Data)
501,335 (89.0%)
5 00 ,00 0
Over 62,000 Rural PC Physicians!
Number of Patient Care Physicians
4 00 ,00 0
% Physicians Rural:
3 00 ,00 0
11.0%
% Population Rural: 19.2%
2 00 ,00 0
1 00 ,00 0
41,125 (7.3%)
14,899 (2.6%)
6,027 (1.1%)
Small Rural
Isolated Small Rural
0
Urban
Large Rural
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Phy/Pop Ratio by Spec & Location
(2005 AMA and AOA Data)
40
FPs
General Internal Medicine
General Pediatrics
General Surgery
OB/GYN
Psychiatry
36.6
35
30.1
29.5
30
Phy/Pop Ratio (per 100,000 pop)
25.6
23.3
25
19.7
20
16.5
12.9 13.5
15
13.3
9.6
10
7.3
8.3
9.3
6.6
5
6.9
6.8
5.1
4.7
3.4
2.1 2.6 1.5 1.6
0
Urban
Large Rural
Small Rural
Isolated Small Rural
FP/Pop Ratio by Rural RUCA Categories by
Persistent Poverty County Status
(2005 AMA and AOA Data)
50
Persistent Poverty County
Other Counties
40
FP/Pop Ratio Per 100,000 Population
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41.6
35.9
32.6
28.7
30
29.3
28.1
22.8
28.5
26.4
22.0
19.2
18.5
20
10
0
Large Rural
Small Rural
Isolated Small
Rural
Less Than 60 Minutes Travel to City (50K+)
Large Rural
Small Rural
Isolated Small
Rural
60 Minutes or More Travel to City (50K+)
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Dentist Vacancy Rates by Location Type
(Federally Funded Health Centers)
Percent Vacancies
40
32.6
30
20
27.2
23.8
15.5
10
0
Urban
Large Rural
Small Rural
Isolated Small
Rural
Source: 2004 Center Survey
Medicare Elderly Visit Origins and Care Destinations
(1998 Medicare Elderly Ambulatory Visits: AK, ID, NC, SC, and WA)
Urban Residents
Large Rural Residents
Large Rural (35%)
Large Rural (2%)
Small Rural (1%)
Small Rural (2%)
Is olated Sm all Ru ral (2 %)
Is olated Sm all Ru ral (0 %)
Urban (78%)
Same ZIP (18%)
Urban (20%)
(Urb an)
Same ZIP (41%)
(La rge Rura l)
Small Rural Residents
Large Rural (11%)
Isolated Smaller Rural Residents
Small Rural (17%)
Small Rural (20%)
Is olated Sm all Ru ral (1 2%)
Is olated Sm all Ru ral (2 %)
Large Rural (27%)
Same ZIP (14%)
(Isolated Sm all Ru ral)
Urban (33%)
Same ZIP (34%)
(Sma ll Rura l)
Urban (30%)
Note : Vo lume of the pies is propo rtion al to th e nu mber of vis its:
Urba n (12 ,389 ,696 ); La rge Rura l (3,499,306); Smal l Rural
(2,696,055), and Iso late d Sma ller rural (1,90 7,20 8).
Figure 2-7: FM Residency Training by Location of Training and Parent Residency Location
(2000 FM Residency Director Survey, n= 435)
Large Rural Communities
Small Rural Communities
Large Rural (85%)
Urban (83%)
Large Rural (4%)
Small Rural (13%)
Small Rural (3%)
Urban (12%)
Isolated Small Rural Communities
Urban (81%)
Large Rural (19%)
Small Rural (0%)
No core residencies were located in
isolated small rural locations.
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SUMMARY
RUCA Version 2.0 is available for use (ZIPs)
RUCAs can be tailored to research/policy
analysis needs
ZIP code-based RUCAs are more sensitive
and adaptable than county-based taxonomies
for analyses
New analysis tools for use with RUCAs will be
available within two weeks
Researchers NEED to pay as much attention
to geographic units as to other methods
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Web Sites
Rural Health Research Center (RUCAs):
http://www.fammed.washington.edu/wwamirhrc/
Center for Health Workforce Studies:
http://www.fammed.washington.edu/CHWS/
Regional Information Center:
http://www.fammed.washington.edu/chws/ric/
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Thanks
garyhart@u.washington.edu
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