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Finding Statistics and Data Related to Rural Health

This guide will help you locate and fairly and accurately use statistics and data in order to:

  • understand rural health needs and rural/urban disparities,
  • communicate rural health needs, and
  • inform decision-making related to service delivery and policy

For a comprehensive look at major rural-relevant statistical sources, please also see RAC's Data Sources & Tools Relevant to Rural Health. This list includes data sources focused on healthcare services, health status, demographics, and social determinants of health. For each source, it identifies the topics covered, ease of use, geographic level of data, and update frequency.

Frequently Asked Questions

What sources collect rural or rural-relevant data?

The USDA Economic Research Service's State Fact Sheets offer total, rural, and urban statistics nationally and for each state on population, income, education, employment, and other topics. It is a quick place to access a range of rural data for your state, pulled from different federal sources.

The U.S. Census Bureau's American Community Survey (ACS) includes data that can be limited to rural, using the Census Bureau definition of rural, as well as the OMB definition of metropolitan and nonmetropolitan areas. The ACS includes a wide range of information on demographics, health insurance coverage, disability, education, poverty, income, and much more.

The Housing Assistance Council's Rural Data Portal provides national and state demographic, social, economic, and housing data, with the option to limit to rural.

For a detailed list of options, see RAC's Data Sources & Tools Relevant to Rural Health, which lists major rural-relevant statistical sources, topics covered, and geographic breakdowns available.

What sources collect county-level data? How might county-level data be useful?

The county (and county equivalents such as parishes in Louisiana and boroughs in Alaska) is a geographic unit that is familiar, easy to understand, and consistent over time. Counties have constant boundaries and so can be useful in comparing changes over time for a set geographic area. A county or set of counties may be a useful service area to describe when applying for funding or describing a particular issue or need.

Many types of data are available at the county level that may not be available specifically for the official "rural" geography as defined by the Census Bureau. Also, counties themselves may be identified as rural, based on the Office of Management and Budget definition of counties as Metropolitan, Micropolitan, or Noncore.  Both the Micropolitan and Noncore counties constitute “nonmetropolitan” areas, which are frequently considered "rural."

  • County Health Rankings and Roadmaps, a program of the Robert Wood Johnson Foundation, brings together county-level health data on key health factors and health outcomes from a wide range of data sources. It is the most broad and easy to access county-level health data available. County Health Rankings and Roadmaps offers recorded webinars that discuss the information available from their web site and how it can be used by communities. They also offer a project showcase that describes ways the County Health Rankings information is being used.
  • The U.S. Census Bureau's State and County QuickFacts offer data on the population and demographics for each county, as well as information on housing, income, and other social determinants of health. QuickFacts also identifies each county's land area and people per square mile.
  • The USDA Economic Research Service's Atlas of Rural and Small-Town America provides access to 60 county-level socioeconomic indicators, including data from the American Community Survey and Bureau of Labor Statistics. The Atlas includes data on total population change trends for particular demographic groups.
  • The USDA Economic Research Service also maintains the Food Environment Atlas, which contains county-level information on social determinants of health, such as access to grocery stores and presence of local farmer’s markets, together with health measures such as child and adult obesity rates.  A related resource, the Food Access Research Atlas, describes food deserts, areas with poor access to high quality foods, at the local level.
  • The Housing Assistance Council's Rural Data Portal provides county-level demographic, social, economic, and housing data.
  • The National Center for Veterans Analysis and Statistics provides downloadable files of county-level statistics related to the Veteran population, covering overall Veteran population estimates, by period of service, as well as information about the number of Veterans receiving care.
  • The Annie E. Casey Foundation's Kids Count Data Center offers county-level data on children covering demographics, and other topics related to children's health and welfare.

For a detailed list of options, see RAC's Data Sources & Tools Relevant to Rural Health, which lists major rural statistical sources, topic covered, and geographic breakdowns available.

What sources provide health services data for rural areas or by county?

The following sources include health services data:

  • Health, United States, a publication from the National Center for Health Statistics, includes nonmetropolitan data on healthcare access and utilization.
  • County Health Rankings & Roadmaps offers county-by-county data on the supply of primary care physicians, dentists, and mental health providers in its Access to Care category of measures.
  • The Robert Graham Center's HealthLandscape interactive mapping system can show the location of healthcare facilities and shortage designation areas, in combination with other county-level data relevant to health. Options are listed under the "Basemaps and Optional Layers" section:

    Screenshot of HealthLandscape Web Page
  • The Health Resources and Services Administration's Area Health Resources Files (AHRF) has county-level data on healthcare facilities, practitioners, and utilization.
  • The Commonwealth Fund's Health System Data Center has data on healthcare access, quality, cost, and outcomes by hospital referral region. Select the "Local Area Ranking" for the scorecard:

    Screenshot of Health Systems Data Center Web Page
  • The Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project (HCUP) offers county-level data for selected states via HCUPnet's County-Level Statistics (beta version) with information for all hospital stays and by procedure or diagnosis, including length of stay, cost per stay, and other utilization information. When selecting your state, be sure to click the small arrow under the year column, rather than the link labeled "Link to State Web Site":

    Screenshot of HCUPnet Web Page
  • The Bureau of Economic Analysis provides maps and data on income by industry at the county level. This information can be narrowed to the NAICS classification of "Health Care and Social Assistance" or more specifically to focus on just ambulatory care or hospitals, although that level of narrowing may result in some counties not having meaningful data.
  • The Centers for Disease Control and Prevention's Interactive Atlas of Heart Disease and Stroke provides county-level data and maps on heart disease and stroke, with information on health services available and location of healthcare facilities.
  • The Centers for Medicare & Medicaid Services Medicare Geographic Variation Dashboards offer county-level data on Medicare fee-for-service costs, with a comparison to state and national averages.
  • The Substance Abuse and Mental Health Services Administration's National Survey on Drug Use and Health includes rural-specific data on mental health services and substance abuse treatment. Look for detailed tables that list "Geographic Characteristics."

What sources cover health behaviors and health status for rural areas or by county?

  • Health, United States, a publication from the National Center for Health Statistics, includes nonmetropolitan data on health status, risk factors, preventive care, and more.
  • The National Health Interview Survey results are published in an annual report titled, Summary Health Statistics for the U.S. Population: National Health Interview Survey, which includes metropolitan versus non-metropolitan data on health status, healthcare access, and limitations in activities due to chronic conditions.
  • County Health Rankings & Roadmaps offers county-by-county data on health behaviors, social and economic factors, and the environment
  • The Robert Graham Center's HealthLandscape provides county-level data on health status and health behaviors.
  • The Centers for Medicare & Medicaid Services Medicare Chronic Conditions Dashboards offer county-level data on chronic disease prevalence, utilization, and spending for Medicare beneficiaries.
  • The Community Commons offers county profiles (free, but registration required) that include information on physical inactivity and smoking, as well as social and economic factors that may impact health.
  • The Commonwealth Fund's Health System Data Center has data on health status by hospital referral region. Select the "Local Area Ranking" for the scorecard and look for "Healthy Lives" under the measures.
  • The Kids Count Data Center includes county-level children's health data on birth outcomes, deaths, participation in federal health-related programs, child abuse and neglect, and other health-related topics.
  • The National Cancer Institute's State Cancer Profiles provide county-level data and maps on cancer burden, by cancer type and demographic group, as well as screening and risk factor data.
  • The Centers for Disease Control and Prevention's Interactive Atlas of Heart Disease and Stroke provides county-level data and maps on heart disease and stroke, with information available by demographic group. It also covers social determinants of health.
  • The USDA Food Environment Atlas provides county-level data on obesity and resources for physical activity.
  • The National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention (NCHHSTP) at the Centers for Disease Control & Prevention sponsors the NCHHSTP Atlas, which provides county-level data for those diseases.  County-level data on HIV are suppressed when there are fewer than five cases.
  • The Substance Abuse and Mental Health Services Administration's National Survey on Drug Use and Health includes rural-specific data on mental health conditions and substance abuse incidence. Look for detailed tables that list "Geographic Characteristics."

How can I use American Factfinder to get U.S. Census Bureau statistics that focus on rural?

This presentation shows how to narrow your results to rural:

How can I use American Factfinder to get U.S. Census Bureau statistics that focus on a specific community?

The American Factfinder: Community Facts offers quick access to community-level data on demographics, income and poverty, education, and more.

What sources of training and technical assistance are available to learn about U.S. Census data?

The U.S. Census Bureau offers a range of educational resources for learning how to use Census Bureau tools and access Census data. These include web-based and in-person classes, online tutorials, and answers to frequently asked questions. In particular, the Census Bureau offers educational resources on health topics.

The Census Bureau has regional offices that provide training and technical assistance regarding Census Bureau data. The Census Bureau also partners with State Data Centers, which offer additional assistance.

What are some of the limitations and considerations related to American Community Survey data for rural areas?

As described in The American Community Survey: What it Means for County Data, a March 2010 RUPRI Data Brief by Kathleen Miller, rural counties have access to ACS estimates averaged over 3- or 5-year periods, compared to the annual estimates available for more populous areas.  Rural areas rely on less-frequent estimates because it takes longer to collect a statistically accurate estimate, given the smaller population.

Population ACS Estimates Available
65,000 or more 1-year
20,000 or more 3-year
Below 20,000 5-year

Some disadvantages identified in the RUPRI Data Brief that result from this averaging include:

  • Rural counties have fewer data points to pick from to demonstrate that they meet criteria listed in funding or other opportunities.
  • High and low points will be harder to pinpoint in time.
  • Highs and lows will be averaged out over the longer time-frame, causing it to appear that rural areas are doing better or worse than they actually are.

This RUPRI map identifies counties by the frequency of estimates available, with yellow counties having 5-year estimates, green having 3-year estimates, and blue having 1-year estimates:

Population Estimate by County, 2013 Map

In a recorded 2011 RAC webinar, American Community Survey: The New Era for Detailed Data, Kathleen Miller covers this issue, as well as other special considerations (look for the section Special Considerations in the online recording, which runs from minute 16:14 to 26:14)  related to the ACS data for rural areas:

  • ACS data should only be compared for the same type of estimate (3-year to 3-year, 5-year to 5-year), and for non-overlapping time periods. An area with 5-year data would only have 2 comparison points per decade. For example 2005-2009 data could be compared to 2010-2014 data.
  • Data for large rural counties in the West are average over both space (due to geographic size) and time (due to 3- or 5-year estimate period)
  • The margin of error for areas with smaller populations may be quite high. ACS data are just estimates.

The August 2009 U.S. Census Bureau report A Compass for Understanding and Using American Community Survey Data: What Users of Data for Rural Areas Need to Know, provides additional insights about how data for rural areas is collected and should be interpreted and used.

What challenges or limitations do researchers face when analyzing health data for rural populations?

A 1998 issue paper from the National Rural Health Association, Facilitating the Use of National Surveys in Rural Health Research, identified confidentiality and sample size as two challenges faced by researchers interested in studying rural populations. Unfortunately, this situation has not changed since the paper was published.

Why do health-related data for rural communities pose confidentiality concerns? An individual with a particular diagnosis might be identifiable based on their condition, either alone or in combination with other data collected. Typically, this type of data is not publicly available, so a researcher who needs access may face barriers or extra steps to get the data.

The sample size collected in rural areas by national surveys may not be adequate to allow for meaningful comparison of the rural area to more populous regions. The ACS addresses this by offering multi-year estimates.

The data I've found seems old. Why are data releases often several years old? How can I decide if the data I have is too old to be useful?

It takes time for data that has been collected to be ready for use. The organization or researcher who collected the data must review it to identify problems such as incomplete submissions, invalid answers, or other problems with the information that makes it suspect. In addition, the data may need to be formatted to match previously collected data and moved to an accessible location.

In addition to the lag time that naturally occurs in collecting and sharing data, there may be gaps because a survey isn't conducted every year or perhaps was a one-time collection that won't be repeated. It is up to you as the user to decide if the older data is still useful or if it would be better to acknowledge that there is no current data available. You could also seek out other sources of data on the topic or request that an organization repeat a survey it has done in the past.

How can I find out how the demographics or population of an area are changing over time?

The USDA Economic Research Service's Atlas of Rural and Small-Town America provides maps and data showing how the population as a whole is changing, as well as population changes by race/ethnicity and by age. ERS also provides a brief overview, with maps and charts, of Recent Population Change for rural areas.

The U.S. Census Bureau's Population Estimates offer both annual and multi-year population change data by county.

The American Community Survey releases data every year. For larger communities, annual estimates can be compared from year to year. For smaller population areas, where multi-year estimates are released care must be taken when comparing overlapping estimates.

How can I compare data for one geographic region or area to another? Why would I want to?

In comparing data from different geographic areas, it is important to be sure that you are comparing similar data - that is, that it was collected using the same methods and for the same time period. Many of the data sources identified here offer data for each state or for each county, allowing you to compare how different areas are faring. This can be helpful, for example, in arguing to funding agencies that there is an unusual need in your area that is important to address.

The AHRF's Health Resources Comparison Tool allows you to select a county and choose from a set of similar counties nationwide or identify specific other counties to compare on a range of health resources and demographic topics.

The American Factfinder’s Geographic Comparison Tables (GCTs) provide statistics compiled for metropolitan, micropolitan, and noncore geographies, as well as for rural and urban geographies. GCTs provide statistics for a group of related geographic areas, such as all counties in a state. A List of Geographies Included in the Geographic Comparison Tables for the 2005-2009 ACS 5-Year Estimates is available for download as an Excel file.

To access GCTs in American Factfinder, from the Advanced Search, select Topics, then Product Type, and then Geographic Comparison Table:

Screenshot of American FactFinder Web Page

From there, you can search for specific topics and geographies that interest to you.

What should I be aware of when seeking to compare data from different sources?

A recorded webinar, Comparing and Linking Survey Data: Considerations for Working with Multiple Data Sources presented by Jill Boylston Herndon of the Institute for Child Health Policy, covers these considerations in comparing data from different sources:

  • primary purpose of the survey
  • target population, as well as what demographic breakdowns are available
  • rural definitions used
  • survey methodology
  • question wording

If you are not trained in health services research, it would likely be easiest and safest to just compare data from the same source, rather than attempting to directly compare data from one source to another. You could instead include charts or tables with data from different sources side-by-side, with relevant information about differences in data collection methods or target audience.

What types of statistical sources can I find for my area on RAC's state guides? What about the state-by-state guide?

Each state guide includes reports and publications specific to that state that address rural health issues, and many of these include statistics. State-produced reports are more likely to focus on concerns that are of particular interest in your state and to look at service areas from a locally-informed perspective.  RAC's state guides may also list web-based resources that provide access to statistics, as well as maps that illustrate health care needs in the state.

The state-by-state guide features resources that provide information for most or all states on topics relevant to rural health. These types of resources can offer additional insights about your state's rural health needs and also offer a comparison to other states.

What types of rural statistics can I find on RAC's topic guides?

RAC's topic guides address many issues important to rural health, such as dental health, minority health, and healthcare quality. The guides identify key reports from federal agencies and national organizations that address the issue, and many of these publications include rural statistics in the form of charts, tables, and maps. The topic guides also list publicly accessible databases and websites that provide statistics. Finally, guide introductions and frequently asked questions often include key statistics as part of their overview of the topic.

What other sources in my state can I contact to find data that may be collected here but not nationally?

These organizations may be able to help you identify additional rural or county-level data available in your state: