Fig 1.
Demonstration of developing a Rurality Scale with three-digit ZIP codes in a de-identified safe harbor dataset.
Fig 2.
An illustration of the coding process for Healthcare Access and Utilization survey questions.
Delayed care was assessed using nine (9) survey items, with participants having six (6) or more affirmative responses coded as 1 and fewer than six (6) coded as 0. Similarly, healthcare affordability was assessed using fourteen (14) survey items, with nine (9) or more affirmative responses coded as 1, and fewer than nine (9) coded as 0.
Fig 3.
Map illustrating the distribution of three-digit ZIP codes by percent rural among All of Us participants in the United States.
Note: The map was created by the authors using publicly available ZIP Code data from the U.S. Census Bureau (available at https://www.census.gov/geographies/mapping-files/time-series/geo/cartographic-boundary.html) and the All of Us Research Program participant data. In accordance with the program policy, this work acknowledges the essential contributions of All of Us participants.
Table 1.
Comparison of the sociodemographic characteristics between 0% rural and 100% rural*.
Fig 4.
The ECDF Plot shows the cumulative distribution of Access to Care along the rurality scale.
At 0% rural, we observe that the two curves uniformly rise steeply, indicating that a significant proportion of the participants have similar levels of access to care. Subsequently, the two curves split at different percentiles, indicating a disparity in access to care with respect to the rural percentage. The orange curve (delayed access to care) indicates that as the percentile increases, those experiencing delayed access to care tend to come from areas with higher rural percentages when compared to those with no delayed access to care (blue curve).
Fig 5.
ECDF Plot showing the cumulative distribution of Healthcare Affordability along the rurality scale.
At 0% rural, we observe that the two curves uniformly rise steeply, indicating that a significant proportion of the participants have similar levels of healthcare affordability. The two curves then split at different percentiles, indicating a disparity in healthcare affordability with respect to the rural percentage. The orange curve (difficulty affording care) indicates that as the percentile increases, those experiencing difficulty affording care tend to come from higher rural percentages when compared to those with no difficulty affording care (blue curve).