摘要：We examined differences in health measures among rural, suburban, and urban residents and factors that contribute to these differences. Whereas differences between rural and urban residents were observed for some health measures, a consistent rural-to-urban gradient was not always found. Often, the most rural and the most urban areas were found to be disadvantaged compared with suburban areas. If health disparities are to be successfully addressed, the relationship between place of residence and health must be understood. DURING THE PAST FEW decades, Americans have continued to experience improvements in health, such as decreased use of tobacco and increased life expectancy. 1 . The health of persons who live in rural areas also has improved, yet rural populations fare worse on many dimensions of health compared with populations at other levels of urbanization, particularly suburban populations. 2, 3 Documenting the extent and the nature of these disparities is necessary for the development of polices and programs designed to eliminate rural disadvantage. The 2001 Urban and Rural Health Chartbook 3 includes health data through 1998 and uses a 5-level rural-urban classification: central counties of large (population ≥ 1 million) metropolitan areas (counties that include all or part of the largest or central city of the metropolitan area), fringe (or suburban) counties within large metropolitan areas, small metropolitan counties (within a metropolitan area with a population of <1 million), nonmetropolitan counties that include a city with 10000 or more residents, and nonmetropolitan counties that do not include a city with 10000 or more residents. These categories were developed in accordance with the 1990 Office of Management and Budget (OMB) standards for defining metropolitan areas and a modification of the urban influence codes (revised December 1996) developed by the Economic Research Service, US Department of Agriculture (USDA). 4 This classification orders counties by degree of urbanization so that central counties of large metropolitan areas are referred to as the most urban and nonmetropolitan counties that do not include a city with 10000 or more residents are referred to as the most rural.
