Death rate difference between rural and urban Americans has tripled in the past 20 years, study finds


The ‘mortality gap’ between urban and rural areas has tripled in just 20 years, with people in rural areas more likely to die from ‘desperate diseases’.

Researchers at Brigham and Women’s Hospital in Boston analyzed deaths from lung disease, heart disease, opioid overdoses and similar causes of death in rural and urban areas across the country, using a database from the Centers for Disease Control and Prevention (CDC). ).

They found that age-adjusted death rates (AAMRs) declined in both rural and urban populations from 1999 to 2019, but they declined much further in urban areas.

In addition, white people aged 25 to 64 in rural areas belonged to a small group whose AAMRs increased during this period.

While deaths from chronic illnesses and “desperate illnesses,” such as opioid addiction or alcoholism, have declined over the past two decades, the gap between urban and rural America has tripled.

The overall AAMR in urban America fell from 861.5 deaths in 100,000 people to 664.5 deaths, a 22 percent drop.

In rural areas, it fell from 923.8 in 100,000 to 834, a decrease of less than ten percent.

The gap between urban and rural areas increased from 62.3 to 169.5, or 172 percent.

“You might think that with medical advances over the course of two decades, the disparities in death rates narrowed, but what we’ve seen is quite the opposite,” said study co-author Dr. Haider Warriach, a member of Brigham’s Heart and Vascular Center. .

“Instead, we saw an unprecedented turnaround in the death rates of middle-aged white people, both men and women.

Traditionally, researchers focusing on rural populations have emphasized the effect of the opioid epidemic and so-called ‘despair diseases’, including alcohol abuse and suicide, but our previous work has shown that chronic conditions can also cause this gap.

‘Rural areas have a higher prevalence of risk factors for these conditions, such as smoking, poor nutrition, lack of exercise and obesity.’

There are several reasons for these problems occurring among the rural population.

A rural American is 30 percent more likely to live in poverty than someone who lives elsewhere.

People in poverty are much more likely to use drugs and alcohol, and are also more likely to have a poor diet, leading to other health problems such as obesity.

In addition, rural Americans also have a harder time accessing health care.

More than 100 nationwide hospitals have Closed since 2010, leaving a population with already scarce options for medical care with even fewer options.

More than 100 rural hospitals have closed in the past decade, including 20 last year, leaving rural Americans with few health care options.  Rural hospital closures have added to the death gap

More than 100 rural hospitals have closed in the past decade, including 20 last year, leaving rural Americans with few health care options. Rural hospital closures have added to the death gap

“A parallel crisis is the record number of hospital closures in rural areas, which will make solving this problem even more difficult with limited access to primary and emergency care,” Warriach said.

The COVID-19 pandemic, which was not investigated as part of this study, exacerbated the problem, with 20 hospitals nationwide closing in 2020.

The researchers indicate that the pandemic probably made the differences found in the study even worse.

Racial differences in AAMR have decreased over the past two decades.

Black people in both rural and urban areas live longer and are less likely to die from a chronic condition.

While there is still a gap, since white Americans are still less likely to die from these conditions than black Americans, the gap across the country has halved.

Black Americans did that more suffering severely affected by the pandemic than white Americans, so the results may look different for a study conducted last year.

The study was published Tuesday in the Journal of the American Medical Association.