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Characterizing rurality using the All of Us Research Program data.

Michael Bradfield1, Toluwanimi Olorunnisola2, Vignesh Subbian2

  • 1Department of Family Medicine, Banner Health North Colorado Medical Center, Greeley, Colorado, United States of America.

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Rural communities face significant health disparities. This study developed a new rurality scale using 3-digit ZIP codes, revealing links between rurality, delayed care, and healthcare affordability challenges.

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Area of Science:

  • Public Health
  • Health Services Research
  • Geographic Information Systems

Background:

  • Rural populations in the US experience worse health outcomes and less healthcare access than urban populations.
  • Existing definitions of rurality in research lack geographic precision, hindering accurate analysis of rural health.
  • The All of Us Research Program has a diverse participant base, but its rural representation needs precise characterization.

Purpose of the Study:

  • To develop and implement a continuous rurality scale using 3-digit ZIP codes for the All of Us Research Program.
  • To assess rural participant distribution within the All of Us Research Program.
  • To investigate the relationship between this rurality scale, delayed healthcare access, and healthcare affordability.

Main Methods:

  • Integrated data from the Federal Office of Rural Health Policy and the Environmental Systems Research Institute.
  • Generated a continuous rurality scale at the 3-digit ZIP code level.
  • Utilized a Kolmogorov-Smirnov test to compare geographic distributions of participants experiencing delayed or unaffordable care.

Main Results:

  • A statistically significant difference was found in the geographic distribution of participants who delayed care (P < 0.001).
  • A statistically significant difference was also observed in the geographic distribution of participants facing healthcare affordability issues (P < 0.001).
  • The developed rurality scale demonstrated reproducibility and extensibility within the All of Us Workbench.

Conclusions:

  • The proposed 3-digit ZIP code-based rurality scale offers a standardized and reproducible method for analyzing rural health.
  • This scale facilitates better understanding of rural health disparities, including delayed care and affordability.
  • The framework supports future research on rural health questions within large-scale biobanks like the All of Us Research Program.