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Title: Rural-Urban Residence and Mortality among Three Cohorts of U.S. Adults

Citation Type: Working Paper

Publication Year: 2020

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Abstract: Though U.S. life expectancy has increased over the past 50 years, this benefit has not been geographically uniform and certain rural persons and communities face a mortality gap.1,2 Rural residents experience a shorter life expectancy than urban residents,³ with higher mortality rates from specific causes such as chronic obstructive pulmonary diseases,⁴ coronary heart disease,⁵ and lung cancer.⁶ Overall, there are higher mortality rates among rural residents for all five leading causes of death – heart disease, stroke, cancer, unintentional injury, and chronic lower respiratory disease – as compared to urban residents.⁷ In addition, residents of poor rural areas had a mortality rate in 2005-2009 that was 42% higher than their affluent urban counterparts, and this disparity has increased over time.⁸ Prior studies suggest that individual and family socioeconomic characteristics are partially responsible for elevated rural mortality.⁹ For example, rural residents have lower incomes, lower educational attainment, and higher rates of being uninsured compared with urban residents;¹⁰ these characteristics have also been associated with higher mortality rates. A 2011 analysis of deaths in the U.S. in 2000 estimated that poverty and low education increased the risk of death by 75% and 80%, respectively, among adults aged 25-64.11 The rural-urban mortality difference is even larger for certain demographic groups. Poor blacks living in rural areas had two to three times the mortality risk as more affluent blacks and whites living in urban areas.⁸ Lack of access to health care may also explain the rural-urban mortality gap. Compared to urban places, rural communities have lower availability of primary care, particularly of specialty care, posing challenges to obtaining needed services for some rural residents. For example, rural residents are diagnosed with cancer at later stages of disease than those living in urban areas, which may be due to their more limited access to preventive care services.12 Diagnosis of cancer at a later stage would account for why residents of rural areas have lower cancer incidence rates but higher death rates than residents of urban areas.13 In addition, rural trauma deaths often occur outside the hospital setting, in contrast to urban areas.14 Further, among adults admitted to hospitals for a heart attack, rural residence is associated with higher rates of death, which may be due to differences in patient risk characteristics, such as higher comorbidity among rural residents, or to health care delivery challenges in rural areas.15,16

Url: https://digitalcommons.usm.maine.edu/cgi/viewcontent.cgi?article=1010&context=population_health

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Authors: Ziller, Erika; Lenardson, Jennifer; Ahrens, Katherine

Series Title: USM Digital Commons

Publication Number: PB-75

Institution: Maine Rural Health Research Center

Pages: 1-9

Publisher Location: Portland, ME

Data Collections: IPUMS Health Surveys - NHIS

Topics: Fertility and Mortality

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