The United States rural population has changed since the 2000 Census; minority populations have increased while overall population growth has slowed. This analysis will identify places of high vulnerability, defined as counties with high proportions of poor and/or minority populations with low or reduced healthcare resources.

Statement of the Problem: The South Carolina Rural Health Research Center last performed a global assessment of rural communities using 2000 data. Population change across the US necessitates an updated assessment of the characteristics and distribution of rural minority populations and the ability of rural communities to serve both minority and white residents.

Project goals: This analysis will identify places of high vulnerability, defined as counties with high proportions of poor and / or minority populations with low or reduced healthcare resources which experienced negative change between 2000 and 2010. These sentinel areas will deserve particular attention during the coming decade, as the effects of the Patient Protection and Affordable Care Act are felt.

Methods: We will conduct cross-sectional analyses of county-level data from the 2000 and 2010 Census, coupled with facility information from the Area Resource File. We will first identify counties that are most vulnerable to poor health because of demographic characteristics, including the proportion of the population that lacks health insurance. County capacity for providing adequate health care will be assessed based on facilities (hospitals, nursing homes) and personnel (provider/population ratios), and changes during the 2000 to 2010 period will be examined. Counties experiencing declines in health care capacity will be identified.

Anticipated publications or products - Results will be presented in both map and tabular form in the project report. Maps that graphically display low resource areas by rurality, census division, high-minority, and high poverty areas will be available at the SCRHRC website. A short video will be developed to summarize study findings.

Publications

• Health-Related Quality of Life Among Adults 65 Years and Older in the United States, 2011-2012: A Multilevel Small Area Estimation Approach
  Journal Article
  Rural and Minority Health Research Center
  Date: 10/2016
  This study compiled estimates, at the county level, of poor health-related quality of life among those ages 65 and older. The study examined physical and mental health and found significant differences in health across the United States.
• Vulnerable Rural Counties: The Changing Landscape, 2000-2010
  Policy Brief
  Rural and Minority Health Research Center
  Date: 07/2016
  This brief illustrates the distribution of rural vulnerable populations and the challenges they face. Understanding the demography of rural America is vital to understanding what programs, interventions and policy initiatives are needed to improve healthcare access, delivery and outcomes.