An assessment of area-level vulnerability and resilience indices by geography: A rural-urban comparison

Purpose

Area-level vulnerability and resilience indices combine multiple dimensions of demographic, economic, and environmental factors into a single measure of area-level risk. These indices are widely used to allocate resources in health care and public health. We investigated how commonly used, existing area-level indices correlate with each other, and how they differ by geography, comparing rural and urban areas.

Methods

Seven publicly available indices were selected for inclusion. Rurality was defined by Rural-Urban Continuum Codes and/or Rural-Urban Commuting Areas, depending on the geographic level of each index. Percentiles were obtained or calculated for each index and compared by rurality.

Findings

We find that these area-level indices are not substitutes for each other, and they differ significantly across the rural-urban continuum in conflicting ways. Three different patterns generally emerged from analysis: indices that increase as geography becomes more rural; indices that decrease as geography becomes more rural; and indices with the greatest values among middle levels of geography.

Conclusions

Findings from this work underscore the importance of better understanding how area-level indices may differ across the United States and by specific populations. When using area-level indices in policy and resource allocation, strategic selection and implementation considering differences by rurality may be warranted.