Arthur G. Cosby, Hasna Khandekar, Willie Brown, and Heather L. Hanna are with the Social Science Research Center, Mississippi State University, Starkville. M. Maya McDoom-Echebiri is with the Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Wesley James is with the Department of Sociology, University of Memphis, Memphis, TN.
Am J Public Health. 2019 Jan;109(1):155-162. doi: 10.2105/AJPH.2018.304787. Epub 2018 Nov 29.
To examine 47 years of US urban and rural mortality trends at the county level, controlling for effects of education, income, poverty, and race.
We obtained (1) Centers for Disease Control and Prevention WONDER (Wide-ranging ONline Data for Epidemiologic Research) data (1970-2016) on 104 million deaths; (2) US Census data on education, poverty, and race; and (3) Bureau of Economic Analysis data on income. We calculated ordinary least square regression models, including interaction models, for each year. We graphed standardized parameter estimates for 47 years.
Rural-urban mortality disparities increased from the mid-1980s through 2016. We found education, race, and rurality to be strong predictors; we found strong interactions between percentage poverty and percentage rural, indicating that the largest penalty was in high-poverty, rural counties.
The rural-urban mortality disparity was persistent, growing, and large when compared to other place-based disparities. The penalty had evolved into a high-poverty, rural penalty that rivaled the effects of education and exceeded the effects of race by 2016. Public Health Implications. Targeting public health programs that focus on high-poverty, rural locales is a promising strategy for addressing disparities in mortality.
控制教育、收入、贫困和种族的影响，检验美国城乡死亡率在县一级 47 年来的趋势。
我们获得了（1）疾病控制与预防中心 WONDER（广泛在线流行病学研究数据）的数据（1970-2016 年），涉及 1.04 亿例死亡；（2）美国人口普查关于教育、贫困和种族的数据；以及（3）经济分析局关于收入的数据。我们为每年计算了普通最小二乘回归模型，包括交互模型。我们绘制了 47 年来标准化参数估计的图表。
城乡死亡率差距从 20 世纪 80 年代中期到 2016 年不断扩大。我们发现教育、种族和农村是强有力的预测因素；我们发现贫困比例和农村比例之间存在强烈的交互作用，这表明最大的惩罚是在高贫困的农村县。
与其他基于地点的差异相比，城乡死亡率差距持续存在且不断扩大。到 2016 年，这种惩罚已经演变成一个高贫困、农村的惩罚，其影响与教育相当，超过了种族的影响。公共卫生意义。针对重点关注高贫困、农村地区的公共卫生项目是解决死亡率差异的一个有前途的策略。
