Rurality and Health in the United States: Do Our Measures and Methods Capture Our Intent?

Rural status in the United States can be objectively measured using multiple designations within different geographic extents, often considering both population density and proximity to urban areas. However, these measurements are often incomplete for assessing the relationship between rural status and health and are often inadequately considered in analysis. To address these limitations, we posit four recommendations: two recommendations to improve current measures by including additional factors and making measures continuous and two recommendations to improve regression analysis by considering rural status as a contextual factor in multilevel modeling and as a variable in conjunction with socioeconomic factors derived through principal component analysis.