Cohen Steven, Metcalf Emily, Brown Monique J, Ahmed Neelam H, Nash Caitlin, Greaney Mary L
Associate Professor, Department of Public Health, University of Rhode Island, Kingston, Rhode Island, USA.
Research Assistant, Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA.
J Rural Health. 2025 Jan;41(1):e12876. doi: 10.1111/jrh.12876. Epub 2024 Aug 28.
Racial health disparities are well documented and pervasive across the United States. Evidence suggests there is a "rural mortality penalty" whereby rural residents experience poorer health outcomes than their urban counterparts. However, whether this penalty is uniform across demographic groups and U.S. regions is unknown.
To assess how rural-urban differences in mortality differ by race (Black vs. White), U.S. region, poverty status, and how rural-urban status is measured.
Age-standardized mortality rates (ASMRs)/100,000 by U.S. county (2015-2019) were obtained by race (Black/White) from the CDC Wonder National Vital Statistics System (2015-2019) and were merged with county-level social determinants from the US Census Bureau and County Health Rankings. Multivariable generalized linear models assessed the associations between rurality (index of relative rurality [IRR] decile, rural-urban continuum codes, and population density) and race-specific ASMR, overall, and by Census region and poverty level.
Overall, average ASMR was significantly higher in rural areas than urban areas for both Black (rural ASMR = 949.1 per 100,000 vs. urban ASMR = 857.7 per 100,000) and White (rural ASMR = 903.0 per 100,000 vs. urban ASMR = 791.6 per 100,000) populations. The Black-White difference was substantially higher (p < 0.001) in urban than in rural counties (65.1 per 100,000 vs. 46.1 per 100,000). Black-White differences and patterns in ASMR varied notably by poverty status and U.S. region.
Policies and interventions designed to reduce racial health disparities should consider and address key contextual factors associated with geographic location, including rural-urban status and socioeconomic status.
种族健康差异在美国有充分记录且普遍存在。有证据表明存在“农村死亡率惩罚”，即农村居民的健康结果比城市居民更差。然而，这种惩罚在不同人口群体和美国各地区是否一致尚不清楚。
评估死亡率的城乡差异如何因种族（黑人与白人）、美国地区、贫困状况以及城乡地位的衡量方式而有所不同。
通过美国疾病控制与预防中心（CDC）的Wonder国家生命统计系统（2015 - 2019年）按种族（黑人/白人）获取美国各县（2015 - 2019年）每10万人的年龄标准化死亡率（ASMR），并将其与美国人口普查局和县级健康排名的县级社会决定因素合并。多变量广义线性模型评估了农村地区（相对农村指数[IRR]十分位数、城乡连续代码和人口密度）与特定种族的ASMR之间的关联，总体情况以及按人口普查区域和贫困水平的情况。
总体而言，农村地区黑人（农村ASMR = 每10万人949.1例 vs. 城市ASMR = 每10万人857.7例）和白人（农村ASMR = 每10万人903.0例 vs. 城市ASMR = 每10万人791.6例）的平均ASMR均显著高于城市地区。城市县的黑人与白人差异（每10万人65.1例）比农村县（每10万人46.1例）高得多（p < 0.001）。ASMR中的黑人与白人差异及模式因贫困状况和美国地区而异。
旨在减少种族健康差异的政策和干预措施应考虑并解决与地理位置相关的关键背景因素影响，包括城乡地位和社会经济地位。
