Each census block is identified by the Census Bureau as belonging to an urbanized area, urban cluster, or rural area.
The resulting comparison group includes teachers from five local school districts, three of which overlap with districts represented by the specialist group: one urbanized area, three urban clusters, and one rural (population less than 2500).
Rural area populations that were near urbanized areas and urban clusters had spatial access to endocrinologists that practiced in them.
Based on standard US Census Bureau urbanized area and urban cluster definitions combined with commuter information, the RUCA codes classify all Census tracts by rural and urban status and relationships.
Over the course of two academic years (2013 2014 and 2014 2015), all EMS and ESS in full-time teaching positions from seven local school districts were invited to participate in this study: one urbanized area (population 50,000 250,000) and six urban clusters (population 2500 50,000).
According to the US 2010 census, 71.2 % of the US population lives in an urbanized area, 9.5 % lives in urban clusters and 19.3 % lives in rural areas [ 19].
Meanwhile, we found that urban cluster populations had less access to urbanized area endocrinologists.
Among 6,501 adult endocrinologists, 6,201 (95.4 %) were located in urbanized areas, 176 (2.7 %) were located in urban clusters and 124 (1.9 %) were located in rural areas.
NECTAs are defined using the same criteria as metropolitan and micropolitan statistical areas and are identified as either metropolitan or micropolitan, based, respectively, on the presence of either an urbanized area of 50,000 or more population or an urban cluster of at least 10,000 but less than 50,000 population.
Similarly among 1,203 pediatric endocrinologists, 1,165 (96.8 %) were located in urbanized areas, but only 17 (1.4 %) were located in urban clusters and 21 (1.8 %) were located in rural areas.
