Self-Reported Versus County-Based Rurality of People Who Gave Birth in 6 US States, 2020.

Abstract

<b>Objectives.</b> To measure concordance between postpartum people's self-reported residence in rural, urban, or suburban areas and county-based measurement of rurality. <b>Methods.</b> We used survey data (collected January 2021-March 2022) from a representative sample of postpartum people with a live birth in 2020 in 6 US states (n = 3225), comparing respondents' self-report to county designations based on Rural‒Urban Continuum Codes (RUCCs). <b>Results.</b> Nearly 80% of postpartum people had concordant self-reported and RUCC-based residency. That is, 70% lived in counties that matched their self-report as urban (19%) or suburban (51%), and 9% lived in counties that matched their self-report as rural. However, almost 20% were rural discordant (lived in urban RUCC counties and self-reported as rural); these residents were more likely to lack a high-school degree and to have Medicaid-paid births compared with concordant respondents living in the same RUCC counties. <b>Conclusions.</b> County-based measures of rurality may incorrectly categorize substantial portions of rural residents, and those potentially misclassified are of lower socioeconomic status. <b>Public Health Implications.</b> Maternal health programs and policies using county-based definitions of rurality should account for rural residents living in areas designated as urban. (<i>Am J Public Health</i>. 2025;115(7):1095-1105. https://doi.org/10.2105/AJPH.2025.308058).