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All rural places are not created equal: Revisiting the rural mortality penalty in the United States

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  • James, W.L.

Abstract

Objectives. I investigated mortality disparities between urban and rural areas by measuring disparities in urban US areas compared with 6 rural classifications, ranging from suburban to remote locales. Methods. Data from the Compressed Mortality File, National Center for Health Statistics, from 1968 to 2007, was used to calculate age-adjusted mortality rates for all rural and urban regions by year. Criteria measuring disparity between regions included excess deaths, annual rate of change in mortality, and proportion of excess deaths by population size. I used multivariable analysis to test for differences in determinants across regions. Results. The rural mortality penalty existed in all rural classifications, but the degree of disparity varied considerably. Rural-urban continuum code 6 was highly disadvantaged, and rural-urban continuum code 9 displayed a favorable mortality profile. Population, socioeconomic, and health care determinants of mortality varied across regions. Conclusions. A 2-decade long trend in mortality disparities existed in all rural classifications, but the penalty was not distributed evenly. This constitutes an important public health problem. Research should target the slow rates of improvement in mortality in the rural United States as an area of concern. © 2014, American Public Health Association Inc. All rights reserved.

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  • James, W.L., 2014. "All rural places are not created equal: Revisiting the rural mortality penalty in the United States," American Journal of Public Health, American Public Health Association, vol. 104(11), pages 2122-2129.
    • Handle: RePEc:aph:ajpbhl:10.2105/ajph.2014.301989_4
    DOI: 10.2105/AJPH.2014.301989
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    Cited by:

    1. Elizabeth Lawrence & Robert A. Hummer & Kathleen Mullan Harris, 2017. "The Cardiovascular Health of Young Adults: Disparities along the Urban-Rural Continuum," The ANNALS of the American Academy of Political and Social Science, , vol. 672(1), pages 257-281, July.
    2. Cattaneo, Andrea & Adukia, Anjali & Brown, David L. & Christiaensen, Luc & Evans, David K. & Haakenstad, Annie & McMenomy, Theresa & Partridge, Mark & Vaz, Sara & Weiss, Daniel J., 2022. "Economic and social development along the urban–rural continuum: New opportunities to inform policy," World Development, Elsevier, vol. 157(C).
    3. Roth, Adam R. & Denney, Justin T. & Amiri, Solmaz & Amram, Ofer, 2020. "Characteristics of place and the rural disadvantage in deaths from highly preventable causes," Social Science & Medicine, Elsevier, vol. 245(C).
    4. Wesley James & Jeralynn Cossman & Julia Wolf, 2018. "Persistence of death in the United States: The remarkably different mortality patterns between America’s Heartland and Dixieland," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 39(33), pages 897-910.
    5. Nathan T. Dollar & Iliya Gutin & Elizabeth M. Lawrence & David B. Braudt & Samuel Fishman & Richard G. Rogers & Robert A. Hummer, 2020. "The persistent southern disadvantage in US early life mortality, 1965‒2014," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 42(11), pages 343-382.
    6. Miller, Charlotte E. & Vasan, Ramachandran S., 2021. "The southern rural health and mortality penalty: A review of regional health inequities in the United States," Social Science & Medicine, Elsevier, vol. 268(C).
    7. Shannon M. Monnat, 2020. "Trends in U.S. Working-Age non-Hispanic White Mortality: Rural–Urban and Within-Rural Differences," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 39(5), pages 805-834, October.
    8. Bednarik, Zuzana, 2023. "The impact of health disparities on the subjective well-being in rural communities," NCR-Stat Discussion Papers 339129, North Central Regional Center for Rural Development (NCRCRD).
    9. Shannon M. Monnat, 2019. "The Contributions of Socioeconomic and Opioid Supply Factors to Geographic Variation in U.S. Drug Mortality Rates," Working Papers Series 87, Institute for New Economic Thinking.
    10. Cheryl Dye & Deborah Willoughby & Begum Aybar-Damali & Carmelita Grady & Rebecca Oran & Alana Knudson, 2018. "Improving Chronic Disease Self-Management by Older Home Health Patients through Community Health Coaching," IJERPH, MDPI, vol. 15(4), pages 1-23, April.

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