County Reclassifications and Rural–Urban Mortality Disparities in the United States (1970–2018)

You must log in or purchase access to view the full text. Log in and purchase options are available below.

Objectives. To demonstrate how inferences about rural–urban disparities in age-adjusted mortality are affected by the reclassification of rural and urban counties in the United States from 1970 to 2018.

Methods. We compared estimates of rural–urban mortality disparities over time, produced through a time-varying classification of rural and urban counties, with counterfactual estimates of rural–urban disparities, assuming no changes in rural–urban classification since 1970. We evaluated mortality rates by decade of reclassification to assess selectivity in reclassification.

Results. We found that reclassification amplified rural–urban mortality disparities and accounted for more than 25% of the rural disadvantage observed from 1970 to 2018. Mortality rates were lower in counties that reclassified from rural to urban than in counties that remained rural.

Conclusions. Estimates of changing rural–urban mortality differentials are significantly influenced by rural–urban reclassification. On average, counties that have remained classified as rural over time have elevated mortality. Longitudinal research on rural–urban health disparities must consider the methodological and substantive implications of reclassification.

Public Health Implications. Attention to rural–urban reclassification is necessary when evaluating or justifying policy interventions focusing on geographic health disparities.

Access content

To read the fulltext, please use one of the options below to sign in or purchase access.




Matthew M. Brooks, MA, J. Tom Mueller, PhD, and Brian C. Thiede, PhDMatthew M. Brooks and Brian C. Thiede are with the Department of Agricultural Economics, Sociology, and Education, Pennsylvania State University, University Park. Tom Mueller is with the Department of Sociology, Social Work, and Anthropology, Utah State University, Logan. “County Reclassifications and Rural–Urban Mortality Disparities in the United States (1970–2018)”, American Journal of Public Health 110, no. 12 (December 1, 2020): pp. 1814-1816.

PMID: 33058708