Technical Notes

Rural/Urban Areas:

For analytical purposes, a classification of areas as being "rural" or "urban" is desired at the county level.  This is because most data is not available at sub-county levels, but is available at the county level.  Prior to June 2003, the Alabama Rural Health Association used the White House's Office of Management and Budget (OMB) classification of counties as being in or not in Metropolitan Statistical Areas (MSAs) in identifying rural or urban status.  Those counties which were included in MSAs were classified as "urban" and those which were not in MSAs were classified as "rural."  A re-determination of counties included in MSAs was announced by OMB in June 2003 and several Alabama counties which must be regarded as being "rural" were included in MSAs in this re-determination.  This made the development of a more acceptable method for classifying counties as "rural" or "urban" necessary.


The method developed and used by the Alabama Rural Health Association uses four variables which are generally accepted as being characteristic of "rural" areas in a formula with each variable accounting for 25 of a possible 100 points.  The higher the overall score, the more "rural" a county is considered as being.  The four variables are as follows:



The percentage of total employment in the county which is  comprised by those employed by the public elementary and secondary school systems.  Since the local school system is the largest single employer in many rural counties, the higher the percentage of employment in school system(s) in relation to total employment, the more rural a county is considered. 



The dollar  value of  agricultural production per square mile of land.  The greater the value of agricultural production per square acre, the more rural the county is considered.



The population per square mile of land.  The fewer the number of persons per square mile, the more  rural a county is considered.



An index  is used to assign a score to counties which considers the population of the largest city in the county, the populations of other cities in the county, and the population of cities which are in more than one county.  Counties where the largest incorporated place has a population of under 2,500 are assigned the highest index score of 25.  Counties where the largest incorporated place has a population of 50,000 or more are assigned the lowest index score of 0.


Using this methodology, 55 Alabama counties are classified as "rural" and 12 are classified as "urban."  The "rural" counties are separated into two groupings for more specific analysis.  One grouping is  based upon the degree to which the counties were considered to be rural.  These groupings are referred to as "Highly Rural" and "Moderately Rural."  The second grouping divides the "rural" counties by geographic region.  Those in the Appalachian Region of North Alabama are referred to as "Rural North" and those in South Alabama are referred to as "Rural South."  The population demographics within these two regions vary significantly which makes analysis of the separate regions informative.  Counties included in the groupings are as follows:

Rural counties

Autauga, Baldwin, Barbour, Bibb, Blount, Bullock, Butler, Chambers, Cherokee, Chilton, Choctaw, Clarke, Clay, Cleburne, Coffee, Colbert, Conecuh, Coosa, Covington, Crenshaw, Cullman, Dale, Dallas, DeKalb, Elmore, Escambia, Fayette, Franklin, Geneva, Greene, Hale, Henry, Jackson, Lamar, Lawrence, Limestone, Lowndes, Macon, Marengo, Marion, Marshall, Monroe, Perry, Pickens, Pike, Randolph, Russell, St. Clair, Sumter, Talladega, Tallapoosa, Walker, Washington, Wilcox, and Winston.


Highly Rural counties

Barbour, Bibb, Blount, Bullock, Butler, Cherokee, Choctaw, Clarke, Clay, Cleburne, Coffee, Conecuh, Coosa, Covington, Crenshaw, Cullman, Dallas, DeKalb, Escambia, Fayette, Franklin, Geneva, Greene, Hale, Henry, Jackson, Lamar, Lawrence, Lowndes, Macon, Marengo, Marion, Marshall, Monroe, Perry, Pickens, Pike, Randolph, Sumter, Washington, Wilcox, and Winston.


Moderately Rural counties

Autauga, Baldwin, Chambers, Chilton, Colbert, Dale, Elmore, Limestone,  Russell, St. Clair, Talladega, Tallapoosa and Walker.


Rural North counties

Bibb, Blount, Chambers, Cherokee, Chilton, Clay, Cleburne, Colbert, Coosa, Cullman, DeKalb, Elmore, Fayette, Franklin, Hale, Jackson, Lamar, Lawrence, Limestone, Macon, Marion, Marshall, Pickens, Randolph, St. Clair, Talladega, Tallapoosa, Walker, and Winston.


Rural South counties

Autauga, Baldwin, Barbour, Bullock, Butler, Choctaw, Clarke, Coffee, Conecuh, Covington, Crenshaw, Dale, Dallas, Escambia, Geneva, Greene, Henry, Lowndes, Marengo, Monroe, Perry, Pike, Russell, Sumter, Washington, and Wilcox.


Urban counties

Calhoun, Etowah, Houston, Jefferson, Lauderdale, Lee, Madison, Mobile, Montgomery, Morgan, Shelby, and Tuscaloosa.




Age-Adjusted Mortality Rate

Age-adjusting is a method of calculating mortality rates which remove differences between the ages of  the populations in different geographical areas or in the same geographical area for different time periods.  It is possible that a mortality rate for a geographical area may be higher than that for another area simply because the area has a greater proportion of elderly in its population and mortality naturally occurs at a higher rate as people get older.  This can also be responsible for different mortality rates for the same geographical area during different time periods. 

In age-adjusting, mortality rates for specific age groups (age-specific mortality rates) are calculated using the actual population of the geographical area.  These age-specific rates are then applied to a standardized population (The 2000 U.S. Standard Population is used in these reports.) to estimate the number of deaths that would have occurred in that standard population and the mortality rate using this expected number of deaths is calculated.  This is the age-adjusted mortality rate.

Age-adjusted rates remove age difference as a factor in comparing the rates, but is only relative in usage.  The rate does not represent the actual number of deaths occurring in the geographical area.  It can only be used to compare the rates of different geographical areas or the same area for different time periods to determine which is greater when age difference is removed as a factor.


Crude Mortality Rate

The "Crude Mortality Rate" is usually simply referred to as the "Mortality Rate."  This rate, as used in these comparison reports, will apply to selected causes of death.  When used in reference to causes of death, this rate is specified as the number of deaths per 100,000 persons in the population of interest.