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Purpose
Use of RUCAs in Health Services Research
™ Introduce Rural-Urban Commuting
Areas (RUCAs) (developed by our Rural
Gary Hart, PhD
Rural Health Research Center
Center for Health Workforce Studies
University of Washington
Seattle, Washington
Health Research Center and ERS)
™ Show Selected Examples
Partners: Dick Morrill (UW) and John Cromartie (ERS)
Academy Health Annual Conference
Seattle, Washington
June 25, 2006
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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
RUCAs
A new Census tract-based taxonomy uses:
™ standard Bureau of Census urbanized
area and place definitions
™ functional relationships per work
commuting flows
™ 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?
But Why Care?
™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
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?
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2
™ Rural varies greatly from place to place
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™ Most rural folks receive most of care
within rural areas
State Line
2
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6
4
5
State Line
State Line
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9
7
State Line
8
10
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County Over
bounding
State Line
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
County Under
bounding
State Line
• ------------------------------------------------------------------------
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Population by RUCA Codes
10
70.3
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(2004 Population Estimates by ZIP Code Area)
(2004 Population Estimates by ZIP Code Area)
9
70.3
9
8
8
7.3
7
Percent of Population
6
5.4
5
6,969,376
4
Urban
7.3
Sub codes (.x) based on second
largest commuting flow.
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Percent of Population
Population by RUCA Codes
10
Large Rural
Small Rural
6
5.4
Isolated Small Rural
5
4
3
3
2.4
2.4
2.1
2
2.1
1.5
2
1.5
1.1
1.0
1
0.4 0.5
0.6
0.7 0.8
0.6 0.6
0.0
0.2 0.3 0.1
0.3
0.1
0.0 0.0 0.1 0.0
0.3
0.1 0.1
1.5
1.5
1.1
1.0
1.0
1
0.4 0.5
0.6
0.1 0.1 0.1
0.0
0
0.7 0.8
0.6 0.6
0.2 0.3 0.1
0.3
0.1
0.0 0.0 0.1 0.0
0.3
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 popu
RUCA Code
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 popu
RUCA Code
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Comparison of OMB (Metro/Non) and RUCA (Urban/Rural)
Comparison of OMB (Metro/Non) and RUCA (Urban/Rural)
(2004 Population Estimates)
85
(2004 Population Estimates)
85
79.9
75
Rural can vary by 26%
75
65
RUCAs can be aggregated differently
65
79.9
Over 56 million rural residents
with this RUCA definition!
55
Percent of Population
55
Percent of Population
1.0
0.1 0.1 0.1
45
8,063,392
2,682,882
35
25
45
35
25
16.0
15
0.9
5
-5
16.0
15
Urban--Metro
Urban--Non Metro
3.2
Rural--Metro
0.9
5
Rural--Non Metro
-5
Urban--Metro
Urban--Non Metro
3.2
Rural--Metro
Rural--Non Metro
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Population by UIC and RUCA Category
RUCA Tools
(2005 AMA and AOA Data)
98
RUCA Categories:
93
92
Urban
Large Rural
Small Rural
Isolated Small Rural
™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)
90
82
77
76
75
Percent by RUCA Category
73
68
61
54
34
30
30
27
13
11
11
10
9
8
1
8
8
9
8
7
7
7
5
4
2
1 0
3
2
2
1
2
0
ALL THESE SHOULD BE ON OUR WEB SITE
WITHIN TWO WEEKS
3
0
0
0
0
0 0
Urban Influence Codes (UICs) (County-Based)
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Patient Care Physicians by RUCA Categories
Examples of RUCA Uses
(2005 AMA and AOA Data)
501,335 (89.0%)
500,000
Federal programs: ORHP, CMS, OAT
National data sets: NSSRN, HCUP
Demography and ERS
Health-Related Research
Over 62,000 Rural PC Physicians!
400,000
Number of Patient Care Physicians
™
™
™
™
% Physicians Rural:
300,000
11.0%
% Population Rural: 19.2%
200,000
100,000
41,125 (7.3%)
14,899 (2.6%)
6,027 (1.1%)
Small Rural
Isolated Small Rural
0
Urban
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Phy/Pop Ratio by Spec & Location
(2005 AMA and AOA Data)
Large Rural
FP/Pop Ratio by Rural RUCA Categories by
Persistent Poverty County Status
50
40
36.6
FPs
General Internal Medicine
General Pediatrics
General Surgery
OB/GYN
Psychiatry
35
30.1
29.5
30
25.6
25
(2005 AMA and AOA Data)
Persistent Poverty County
Other Counties
41.6
40
35.9
32.6
28.7
30
29.3
28.1
23.3
22.8
19.7
20
12.9 13.5
7.3
8.3
19.2
18.5
10
9.3
6.9
6.8
6.6
5.1
5
4.7
3.4
2.1 2.6 1.5 1.6
0
Urban
26.4
13.3
9.6
10
28.5
22.0
20
16.5
15
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Large Rural
Small Rural
Isolated Small Rural
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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IV Nitroglycerin for AMI Medicare Patients
by Hospital Location
Dentist Vacancy Rates by Location Type
(1994/95 Medicare Cardiovascular Project (CCP) data)
80
(Federally Funded Health Centers)
40
70.4
Percent Vacancies
32.6
30
70
27.2
23.8
20
65.1
59.0
60
51.3
50
40
15.5
30
10
20
10
0
0
Urban
Large Rural Small Rural Isolated Small
Rural
Source: 2004 Center Survey
Medicare Elderly Visit Origins and Care Destinations
Urban Areas
AMI001
Large Rural
City Areas
Small Rural
Town Areas
Remote Smaller
Rural Town Areas
n= 102289; 28515; 11862; and 2092.
10/26/01
Figure 2-7: FM Residency Training by Location of Training and Parent Residency Location
(1998 Medicare Elderly Ambulatory Visits: AK, ID, NC, SC, and WA)
(2000 FM Residency Director Survey, n= 435)
Urban Residents
Large Rural Residents
Large Rural Communities
Large Rural (35%)
Small Rural Communities
Large Rural (85%)
Large Rural (2%)
Small Rural (1%)
Small Rural (2%)
Isolated Small Rural (2%)
Isolated Small Rural (0%)
Urban (83%)
Urban (78%)
Large Rural (4%)
Same ZIP (18%)
Urban (20%)
(Urban)
Small Rural (13%)
Same ZIP (41%)
Small Rural (3%)
(Large Rural)
Urban (12%)
Small Rural Residents
Large Rural (11%)
Isolated Smaller Rural Residents
Isolated Small Rural Communities
Small Rural (17%)
Small Rural (20%)
Isolated Small Rural (12%)
Isolated Small Rural (2%)
Urban (81%)
Large Rural (27%)
Same ZIP (14%)
(Isolated Small Rural)
Urban (33%)
Large Rural (19%)
Same ZIP (34%)
(Small Rural)
Small Rural (0%)
Urban (30%)
No core residencies were located in
isolated small rural locations.
Note: Volume of the pies is proportional to the number of visits:
Urban (12,389,696); Large Rural (3,499,306); Small Rural
(2,696,055), and Isolated Smaller rural (1,907,208).
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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/
Thanks
Center for Health Workforce Studies:
http://www.fammed.washington.edu/CHWS/
garyhart@u.washington.edu
Regional Information Center:
http://www.fammed.washington.edu/chws/ric/
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