Rising Health Disparity: Limited Rural Access Intensifies Gap

TL/DR –

The mortality rate for people aged 25 to 54 living in rural areas is increasing compared to their urban peers, according to a recent report by the Department of Agriculture’s Economic Research Service. The gap in natural-cause mortality rates between urban and rural residents has grown from 6% in 1999 to 43% in 2019, largely driven by a rise in deaths among women in rural areas due to preventable or treatable diseases. The study suggests that disparities in healthcare resources, higher rates of poverty, disability, chronic disease, the closure of rural hospitals, and fewer physicians in rural areas have contributed to this trend.

Health Disparities Between Rural and Urban Areas in the US

Matthew Roach, vital statistics manager for the Arizona Department of Health Services, has observed an alarming trend in mortality rates that has caused concern amongst rural health experts. The gap in mortality rates between rural and urban populations in Arizona is growing, reflecting a national pattern.

A recent report from the Department of Agriculture’s Economic Research Service revealed that these health disparities have widened over the last few decades. The research found that rural Americans, especially those between the ages of 25 to 54, suffer significantly higher mortality rates from natural causes such as chronic diseases and cancer than their urban counterparts.

The research used CDC death data from two periods, 1999-2001 and 2017-2019. In 1999, natural-cause mortality rate for rural residents aged 25 to 54 was only 6% higher than for those in cities. By 2019, the disparity had grown to 43%.

The research shows that the expanding gap is driven by a surge in mortality rates among rural women due to treatable or preventable diseases. Cancer and heart disease were the leading causes of death for both men and women in rural and urban areas. For rural women, lung disease, hepatitis, and pregnancy-related deaths showed significant growth.

The study also highlighted severe trends among rural non-Hispanic American Indian and Alaska Native people. Over the two decades, Native Americans aged 25 to 54 had a 46% increase in natural-cause mortality rate. The rate for Native women rose by 55%, while the rate for non-Hispanic White women increased by 23%.

Increased mortality rates signify worsening population health, impacting local economies and employment. This data should prompt stronger policies focusing on rural health, say experts. Alan Morgan, CEO of the National Rural Health Association, called the report “shocking” and called for greater attention to these disparities from state and national leaders.

The study did not explore the causes for the increase in mortality rates but noted that the differences in healthcare resources could affect access, quality, and affordability of care in rural areas. The lack of healthcare services, higher rates of poverty, more chronic diseases, and less physicians per capita in rural areas may result in poorer community health. Roach also pointed out that rural counties and reservations in Arizona show high vulnerability rankings, indicating less resilience against adverse health outcomes.

Janice C. Probst, a retired professor focused on rural health, suggested a community approach to address these disparities. She noted that states with the highest rates of natural-cause mortality in rural areas such as South Carolina, Mississippi, Georgia, Alabama, and others have not expanded Medicaid, the federal and state health insurance program for low-income people. Efforts to expand Medicaid are underway in some states, notably in Mississippi.

Wesley James, founding executive director of the Center for Community Research and Evaluation, at the University of Memphis, suggested state lawmakers could help by pushing for Medicaid expansion in their states, thereby increasing access to healthcare in rural areas. According to KFF polling, two-thirds of people living in nonexpansion states want their state to expand the health insurance program.

The study did not include deaths due to the Covid-19 pandemic, which heavily impacted rural areas. “Covid really changed the nature of public health in rural America,” said Morgan, who urged the CDC to examine rural-urban life expectancies during and post-Covid. In Arizona, the leading cause of death for people aged 45 to 64 in 2021, in both rural and urban areas, was Covid, according to Roach.

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