Disease is factor in higher death rate in rural America

While the U.S. mortality rate is lower than in the 1960s, the urban rate has declined more rapidly than the rural rate, especially in the past generation. Three USDA analysts said a notable factor was a higher death rate from disease among working-age people in rural America.

“In 2019, natural-cause mortality (NCM) rates for the prime working-age population in rural areas was 43 percent higher than in urban areas, up from 6% higher in 1999,” wrote the analysts in a USDA report. The increase for that age group stood out from the change for the overall rural population of having a NCM death rate that was 6% higher in 1999 and 20 percent higher in 2019.

“Geographically, females in rural areas had larger increases in prime working age NCM rates than white males across all regions, with the greatest increases in the West United States. This research further supports the hypothesis that rural populations may be at a health disadvantage, especially for prime working-age populations.”

For their study, the researchers analyzed death certificates for sex, race, ethnicity, residence, cause of death, and year of death. Urban and rural areas saw increases in death rates from drug overdoses, suicide and alcohol during the 20 years ending in 2019.

“However, rural areas alone experienced increases in disease-related or natural-cause mortality rates among the prime working-age population,” said researchers Kelsey Thomas, Elizabeth Dobis, and David McGranahan. The urban rate decreased by 37 deaths per 100,000 people while the rural rate increased by 14 deaths per 100,000. The combined gap of 51 deaths per 100,000 people “indicates a growing rural health disadvantage,” they said.

The change in NCM mortality rates was greatest in the most remote areas.

“It is plausible that differences in healthcare resources and health behaviors across urban and rural areas could contribute to the stagnation and even increasing mortality rates in rural areas, as the accessibility, quality, and affordability of care could be compromised,” said the authors.

Poverty rates are higher and educational attainment rates are lower in rural areas than in the city. Previous studies have found higher rates of chronic disease in rural areas and a greater probability of death from heart disease, cancer, and stroke than in metropolitan areas.

The report, “The nature of the rural-urban mortality gap,” is available here.