A new study by Syracuse University sociology professor Shannon Monnat, PhD, found that mortality rates are higher for US working-age residents who live in rural areas instead of metro areas, and the gap is getting wider, according to a press release.

The study, “Trends in U.S. Working-Age non-Hispanic White Mortality: Rural-Urban and Within-Rural Differences,” found that the US rural mortality penalty is wide and further expanding, which applies to the rural population overall, or all racial/ethnic groups combined, and for non-Hispanic whites, non-Hispanic blacks, and Hispanics individually.

Further, smaller rural declines in mortality from cancers and cardiovascular disease—and larger increases in metabolic and respiratory diseases, suicide, alcohol-related, and mental/behavioral disorders—collectively drove the growth in the rural disadvantage, with trends for females particularly concerning, according to the study.

However, the study found that the rural United States is not monolithic and some rural places have experienced much larger mortality rate increases than others over the past 30 years.

There are large divisional disparities, with particularly poor trends in New England, South Atlantic, East South Central, West South Central, and Appalachia and more favorable trends in the Mid-Atlantic, Mountain, and Pacific. Further, mining-dependent counties have very high mortality rates and have diverged from other economies since the mid-2000s due to multiple causes of death, whereas farming counties have comparatively lower mortality rates.

Although these findings are crucial, Monnat said that not all of rural America is in dire straits.

“While there is much to be concerned about in Appalachia, the South, and increasingly New England, some groups have seen improvement in the Mid-Atlantic, East North Central, and Mountain divisions," Monnat said in a press release. "My analysis of specific causes of death begins to offer insight into what's driving these disparities, but research is needed that identifies the specific upstream causal explanations for these trends, particularly those that are amenable to policy change."

In terms of policy change, Monnat noted that behavioral interventions targeting smoking, diet, and exercise have been widely advocated and have been attempted for decades but appear to have had little impact on reducing rural-urban or within-rural disparities.

“This approach has been costly and ineffective because it treats problems after they arise rather than preventing their onset," Monnat said. "Instead, the more cost-effective and humane approach would be to apply upstream interventions that target the structural (economic, social, environmental), corporate, and policy determinants of health to prevent future generations from exacerbating these already problematic mortality trends."

REFERENCE
Mortality rate higher for US rural residents. EurekAlert! https://www.eurekalert.org/pub_releases/2020-10/su-mrh102020.php. Published October 20, 2020. Accessed October 22, 2020.