Rural health and depression in older adults: Does choice of rurality measurement matter?

Rural populations face numerous distinct health care issues, beyond those encountered by the population as a whole. As the population ages, understanding the specific needs of rural older adults is essential to ensuring that each older adult, regardless of their geographic location, has access to high-quality preventive services and health care, available social support necessary to live independently, and options for when independent living is no longer an option. However, quantifying and defining “rural" has been a persistent challenge in public health research. Therefore, the objectives of this study are to describe, compare, and contrast five common measures of rurality in US counties, overall and by region; demonstrate how the population prevalence of depression varies rurality, and how the inferences about the association between rurality and depression depends upon rurality measurement. Depression was abstracted from the Behavioral Risk Factor Surveillance System. We abstracted five measures of reality from the 2010 US Census and the USDA to characterize US counties, including rural-urban continuum codes, influence codes, and population density quartile. The highest observed rank correlation between different sources (Census vs. USDA) was between rural-urban continuum codes and percent urban population (rho = 0.447, p < 0.001). Non-monotonic associations were observed between depression and rurality in older adults, but the strength of those associations varied substantially by rurality measurement. Developing meaningful and universally accepted rurality measures for public health research and basing programs and policies to target those areas most in need are essential to ensure equal access for rural older adults.