Metrics of Urbanicity and Rurality in US-Based Epidemiologic Studies of Ambient Temperature and Health: A Scoping Review

Authors

Nicholaus P. Johnson, Yale School of Public Health, New Haven, Connecticut, 06510, USA.
Alexandra Del Favero-Campbell, Dalhousie University, Halifax, Nova Scotia, B3H 4R2, Canada.
Amruta Nori-Sarma, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, 02115, USA.
Audrey Amezcua-Smith, Yale School of the Environment, New Haven, Connecticut, 06511, USA.
Brandon Lewis, Yale School of the Environment, New Haven, Connecticut, 06511, USA.
Chen Chen, Scripps Institution of Oceanography, University of California, La Jolla, San Diego, California, 92037, USA.
Chengyi Lin, Yale School of Public Health, New Haven, Connecticut, 06510, USA.
Damien Foo, Yale School of the Environment, New Haven, Connecticut, 06511, USA.
Garam Byun, Yale School of the Environment, New Haven, Connecticut, 06511, USA.
Hayon Michelle Choi, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, 02115, USA.
Honghyok Kim, University of Illinois Chicago School of Public Health, Chicago, Illinois, 60612, USA.
Jesse D. Berman, University of Minnesota School of Public Health, Minneapolis, Minnesota, 55455, USA.
Ji-Young Son, Yale School of the Environment, New Haven, Connecticut, 06511, USA.
Joshua L. Warren, Yale School of Public Health, New Haven, Connecticut, 06510, USA.
Kai Chen, Yale School of Public Health, New Haven, Connecticut, 06510, USA.
Kate Burrows, Department of Public Health Sciences, University of Chicago, Chicago, Illinois, 60637, USA.
Kelvin C. Fong, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
Leo Goldsmith, Yale School of the Environment, New Haven, Connecticut, 06511, USA.
Marie-Claire Meadows, University of Minnesota School of Public Health, Minneapolis, Minnesota, 55455, USA.
Morrison Smith, The Pennsylvania State University Social Sciences Research Institute, State College, Pennsylvania, 16802, USA.
Rory Stewart, Yale School of the Environment, New Haven, Connecticut, 06511, USA.
Seulkee Heo, Yale School of the Environment, New Haven, Connecticut, 06511, USA.
Shuqi Lin, Yale School of Public Health, New Haven, Connecticut, 06510, USA.
Xuejuan Ning, Yale School of Public Health, New Haven, Connecticut, 06510, USA.
Yongsoo Choi, Yale School of the Environment, New Haven, Connecticut, 06511, USA.
Michelle L. Bell, Yale School of the Environment, New Haven, Connecticut, 06511, USA.
Nicole C. Deziel, Yale School of Public Health, New Haven, Connecticut, 06510, USA. nicole.deziel@yale.edu.

Document Type

Journal Article

Publication Date

8-20-2025

Journal

Current environmental health reports

Volume

12

Issue

1

DOI

10.1007/s40572-025-00494-7

Keywords

Ambient temperature; Environmental epidemiology; Heat wave; Rural health; Urban health

Abstract

BACKGROUND: The impacts of environmental health risk factors, including temperature, vary across urban and rural areas. Application of different metrics of rurality and urbanicity can yield different risk characterizations. We aimed to identify, describe, and quantify how urban/rural metrics are used in epidemiologic studies of ambient temperature and health across the United States (US). METHODS: Using PubMed and Scopus, we identified epidemiologic studies published between January 2010 and March 2025 that examined ambient temperature and health in the US and included a defined, quantitative metric of urbanicity/rurality. Titles, abstracts, and full texts were evaluated by two independent reviewers. Data from included studies were extracted using a predetermined tool. RESULTS: Of the 11,013 studies resulting from our search, 36 were included. We identified 23 metrics drawing from 10 data sources. The most frequently used metrics were population density and size from the US Census (n = 11 studies). Other metrics reflected connectivity and proximity to surrounding areas, such as the US Census’s Urban-Rural Classification (n = 7 studies), and the US Department of Agriculture’s Rural-Urban Commuting Area Codes (n = 4 studies) and Rural-Urban Continuum Codes (n = 2 studies). Additional metrics captured features related to the natural environment, built environment, and employment. Many studies did not provide a rationale for metric selection. DISCUSSION: Urbanicity and rurality metrics have moved beyond population size and density to include other features. Providing rationales for choice of metric or the differential vulnerability or adaptive capacity captured by the metric could bolster understanding of urban-rural differences in the impact of temperature on health. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40572-025-00494-7.

APA Citation

Johnson, Nicholaus P.; Del Favero-Campbell, Alexandra; Nori-Sarma, Amruta; Amezcua-Smith, Audrey; Lewis, Brandon; Chen, Chen; Lin, Chengyi; Foo, Damien; Byun, Garam; Choi, Hayon Michelle; Kim, Honghyok; Berman, Jesse D.; Son, Ji-Young; Warren, Joshua L.; Chen, Kai; Burrows, Kate; Fong, Kelvin C.; Goldsmith, Leo; Meadows, Marie-Claire; Smith, Morrison; Stewart, Rory; Heo, Seulkee; Lin, Shuqi; Ning, Xuejuan; Choi, Yongsoo; Bell, Michelle L.; and Deziel, Nicole C., "Metrics of Urbanicity and Rurality in US-Based Epidemiologic Studies of Ambient Temperature and Health: A Scoping Review" (2025). GW Authored Works. Paper 7739.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/7739

Department

Environmental and Occupational Health