Concordance of Rural-Urban Self-identity and ZIP Code-Derived Rural-Urban Commuting Area (RUCA) Designation

Purpose: This study examined the concordance between individuals' self-reported rural-urban category of their community and ZIP Code-derived Rural-Urban Commuting Area (RUCA) category. Methods: An Internet-based survey, administered from August 2017 through November 2017, was used to collect participants' sociodemographic characteristics, self-reported ZIP Code of residence, and perception of which RUCA category best describes the community in which they live. We calculated weighted kappa (kappa) coefficients (95% confidence interval [CI]) to test for concordance between participants' ZIP Code-derived RUCA category and their selection of RUCA descriptor. Descriptive frequency distributions of participants' demographics are presented. Findings: A total of 622 survey participants, residents of New Hampshire (63%) and Vermont (37%), responded to the survey's self-reported rural-urban category. The overall kappa was 0.33 (95% CI: 0.27-0.38). The highest concordance was found among those living in a small rural area (N = 81, 13%): 62% of this group identified their communities as small rural. Sixty-five percent (300/459) of participants residing in urban or large rural areas reported their community as more rural (small rural or isolated). Sixty-eight percent (111/163) of participants living in small rural or isolated areas identified their community as more urban (large rural or urban). Conclusions: Discordance was found between self-report of rural-urban category and ZIP Code-derived RUCA designation. Caution is warranted when attributing rural-urban designation to individuals based on geographic unit, since perceived rurality/urbanicity of their community that relates to health behaviors may not be reflected.