2013 NCHS Urban–Rural Classification Scheme for 2014 Counties April 166 Number 2, Series Copyright information All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated. Suggested citation Ingram DD, Franco SJ. 2013 NCHS urban–rural classification scheme for counties. National Center for Health Statistics. Vital Health Stat 2(166). 2014. Library of Congress Catalog Number 614.4’273—dc23 For sale by the U.S. Government Printing Office Superintendent of Documents Mail Stop: SSOP Washington, DC 20402–9328 Printed on acid-free paper. Series 2, Number 166 2013 NCHS Urban–Rural Classification Scheme for Counties Data Evaluation and Methods Research U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics Hyattsville, Maryland April 2014 DHHS Publication No. 2014–1366 National Center for Health Statistics Charles J. Rothwell, M.S., M.B.A., Director Jennifer H. Madans, Ph.D., Associate Director for Science Office of Analysis and Epidemiology Irma E. Arispe, Ph.D., Director Contents Acknowledgments ........................................................................................ iv Abstract ................................................................................................. 1 Introduction .............................................................................................. 1 2013 NCHS Urban–Rural Classification Scheme for Counties ..................................................... 2 2010 OMB Metropolitan–Nonmetropolitan Classification of Counties ............................................. 2 County Urbanization Levels Defined ........................................................................ 2 Assignment of Counties to the Six Levels of the 2013 NCHS Scheme............................................. 2 Changes in County Urbanization Category: Comparing 2013 and 2006 Schemes .................................... 4 Health Measures by Urbanization Level ....................................................................... 5 Considerations When Analyzing Trends Using Urbanization Classification Schemes.................................... 6 Summary ................................................................................................ 6 References ............................................................................................... 7 Appendix I. Assignment of Large Metropolitan Counties .......................................................... 12 Appendix II. List of U.S. Counties and County-equivalent Entities and Their Urbanization-level Assignments............... 25 List of Detailed Tables 1. Categories and classification rules of the 2013 NCHS Urban–Rural Classification Scheme for Counties ............. 8 2. Number of counties and percentage of the U.S. population in each urbanization level of the 2013 and 2006 NCHS Urban–Rural Classification Schemes for Counties ......................................................... 8 3. Median for selected county characteristics, by urbanization level: 2013 NCHS Urban–Rural Classification Scheme for Counties .......................................................................................... 9 4. Classification of counties according to the 2013 and 2006 NCHS Urban–Rural Classification Schemes for Counties .... 9 5. Age-adjusted death rates for all causes, by age, sex, and NCHS Urban–Rural Classification Scheme for Counties: United States, average annual 2008–2010 ................................................................ 10 6. Age-adjusted death rates for selected causes, by sex and NCHS Urban–Rural Classification Scheme for Counties: United States, average annual 2008–2010 ................................................................ 11 7. Selected health measures for persons aged 18–64, by NCHS Urban–Rural Classification Scheme for Counties: National Health Interview Survey, 2010–2012 .................................................................... 11 List of Appendix Tables I. Comparison of classification rule and discriminant model assignments of large metro counties to large central and large fringe metro categories: 2013 NCHS Urban–Rural Classification Scheme for Counties ...................... 12 II. Classification rule and discriminant model assignments of the large metro counties and county-equivalent entities with discordant assignments and their final assignments: 2013 and 2006 NCHS Urban–Rural Classification Schemes for Counties .......................................................................................... 13 III. First quartile, median, and third quartile of selected characteristics of large central and large fringe metro counties: 2013 NCHS Urban–Rural Classification Scheme for Counties ............................................... 14 IV. Counties in large metropolitan statistical areas (1 million or more population) and their 2013 and 2006 NCHS Urban–Rural Classification Scheme assignments, by February 2013 Office of Management and Budget-designated metropolitan statistical area ........................................................................... 15 V. List of U.S. counties and county-equivalent entities and their urbanization levels: 2013, 2006, and 1990 census-based NCHS Urban–Rural Classification Scheme for Counties .................................................... 26 iii Acknowledgments The authors gratefully acknowledge the contributions made by Jeffrey Pearcy who created the map of the 2013 NCHS Urban–Rural Classification Scheme for Counties and Shilpa Bengeri who did the computer programming for the National Health Interview Survey data examples. The authors also gratefully acknowledge the assistance of the following people at NCHS who reviewed this report: Jeffrey Berko, Jennifer D. Parker, Julia S. Holmes, and Jennifer H. Madans. The report was edited and produced by NCHS Office of Information Services, Information Design and Publishing Staff: Jen Hurlburt edited the report, typesetting was done by Annette F. Holman, and graphics were produced by Sarah Hinkle. iv Objectives This report details development of the 2013 NCHS Urban–Rural 2013 National Center for Health Statistics’ (NCHS) Urban–Rural Classification Classification Scheme for Scheme for Counties (update of the 2006 NCHS scheme) and applies it to health measures to demonstrate urban-rural Counties health differences. by Deborah D. Ingram, Ph.D., and Sheila J. Franco, Office of Methods Analysis and Epidemiology The methodology used to construct the 2013 NCHS scheme was the same as that used for the 2006 NCHS scheme, but 2010 census-based data were used rather than 2000 census-based data. All U.S. Release of 2010 census-based counties and county-equivalent entities are Introduction assigned to one of six levels (four population data, and of MSA and metropolitan and two nonmetropolitan) micropolitan statistical area delineations Urban–rural differences in health based on: 1) their February 2013 Office of based on the application of the 2010 Management and Budget designation as measures have long been recognized. OMB standards for defining these areas metropolitan, micropolitan, or noncore; 2) The National Center for Health to 2010 census data, prompted this for metropolitan counties, the population Statistics’ (NCHS) Urban–Rural update of the 2006 NCHS scheme. The size of the metropolitan statistical area Classification Scheme for Counties was updated scheme will be referred to as (MSA) to which they belong; and 3) for developed for use in studying the 2013 NCHS Urban–Rural counties in MSAs of 1 million or more, the associations between urbanization level Classification Scheme for Counties. location of principal city populations within of residence and health and for The NCHS urban–rural schemes are the MSA. The 2013 and 2006 NCHS monitoring the health of urban and rural county-based because counties generally schemes were applied to data from the residents. The scheme groups U.S. are the primary political units of local National Vital Statistics System (NVSS) counties and county-equivalent entities and National Health Interview Survey government and have programmatic into six urbanization levels (four (NHIS) to illustrate differences in selected importance at the federal and state health measures by urbanization level and metropolitan and two nonmetropolitan), levels, and their boundaries are to assess the magnitude of differences on a continuum ranging from most relatively stable. Further, county-level between estimates from the two schemes. urban to most rural. (Note: In this measures of health and of demographic, report, the term counties will be used to economic, and environmental Results and Conclusions refer to counties and county-equivalent characteristics are widely available, in County urban-rural assignments under entities.) contrast to the paucity of data available the 2013 NCHS scheme are very similar The first NCHS urban–rural at the subcounty level. to those under the 2006 NCHS scheme. scheme, developed in 2001 and referred A distinguishing feature of the Application of the updated scheme to to as the 1990 census-based NCHS NCHS urban–rural schemes is that they NVSS and NHIS data demonstrated the urban–rural scheme, was a six-level separate counties in the largest continued usefulness of the six categories classification scheme for counties. This metropolitan areas (MSAs with for assessing and monitoring health scheme was