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. 2025 Jan 2;25(1):2.
doi: 10.1186/s12913-024-12109-2.

Health differences between rural and non-rural Texas counties based on 2023 County Health Rankings

Elizabeth Ekren  1 , Shadi Maleki  2 , Cristian Curran  3 , Cassidy Watkins  3 , Melinda M Villagran  4
Affiliations

Health differences between rural and non-rural Texas counties based on 2023 County Health Rankings

Elizabeth Ekren et al. BMC Health Serv Res. .

Erratum in

Abstract

Background: Place matters for health. In Texas, growing rural populations face a variety of structural, social, and economic disparities that position them for potentially worse health outcomes. The current study contributes to understanding rural health disparities in a state-specific context.

Methods: Using 2023 County Health Rankings data from the University of Wisconsin Population Health Institute, the study analyzes rural/non-rural county differences in Texas across six composite indexed domains of health outcomes (length of life, quality of life) and health factors (health behavior, clinical care, socioeconomic factors, physical environment) with a chi-square test of significance and logistic regression.

Results: Quartile ranking distributions of the six domains differed between rural and non-rural counties. Rural Texas counties were significantly more likely to fall into the bottom quartile(s) in the domains of length of life and clinical care and less likely to fall into the bottom quartile(s) in the domains of quality of life and physical environment. No differences were found in the domains of health behavior and socioeconomic factors. Findings regarding disparities in length of life and clinical care align with other studies examining disease prevalence and the unavailability of many health services in rural Texas. The lack of significant differences in other domains may relate to indicators that are not present in the dataset, given studies that find disparities relating to other underlying factors.

Conclusions: Texas County Health Rankings data show differences in health outcomes and factors between rural and non-rural counties. Limitations of findings relate to the study's cross-sectional design and parameters of the secondary data source. Ultimately, results can help state health stakeholders, especially those in community or operational contexts with limited resources or access to more detailed health statistics, to use the CHR dataset to consider more relevant local interventions to address rural health disparities.

Keywords: County Health Rankings; Health disparities; Health outcomes; Rural health; Rural urban continuum code; Rurality; Texas.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study did not meet the definition of human subjects research as determined by the IRB of the authors’ institution (IRB FWA00000191); therefore there are no ethics considerations to disclose. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Uninsured individuals across rural and non-rural counties in Texas. Map is author-generated. The Human Geography Basemap is sourced from ArcGIS Pro 3.3.2., a product of Esri. Health insurance data is sourced from the Census and retrieved via SimplyAnalytics accessed through an institutional license. RUCC classification is sourced from the USDA [82]
Fig. 2
Fig. 2
Poverty distribution across rural and non-rural counties in Texas. Map is author-generated. The Human Geography Basemap is sourced from ArcGIS Pro 3.3.2., a product of Esri. Poverty data is sourced from the Census and retrieved via SimplyAnalytics accessed through an institutional license. RUCC classification is sourced from the USDA [82]
Fig. 3
Fig. 3
Non-rural (RUCC 1 – 3) and rural (RUCC 4 – 9) counties across Texas in 2023. Map is author-generated. The Human Geography Basemap is sourced from ArcGIS Pro 3.3.2., a product of Esri. RUCC classification is sourced from the USDA [82]
Fig. 4
Fig. 4
2023 CHR domain quartile distribution for length and quality of life across Texas. Map is author-generated. The Human Geography Basemap is sourced from ArcGIS Pro 3.3.2., a product of Esri. Quartile data is author-generated from CHR rankings [11]. RUCC classification is sourced from the USDA [82]
Fig. 5
Fig. 5
2023 CHR domain quartile distribution for socioeconomic factors and physical environment across Texas. Map is author-generated. The Human Geography Basemap is sourced from ArcGIS Pro 3.3.2., a product of Esri. Quartile data is author-generated from CHR rankings [11]. RUCC classification is sourced from the USDA [82]
Fig. 6
Fig. 6
2023 CHR domain quartile distribution for health behavior and clinical care across Texas. Map is author-generated. The Human Geography Basemap is sourced from ArcGIS Pro 3.3.2., a product of Esri. Quartile data is author-generated from CHR rankings [11]. RUCC classification is sourced from the USDA [82]
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