Differences in Rural and Urban Mortality: Implications for Health Education and Promotion*

Abstract

Rural health care delivery is often inferior to that of urban areas. Although health services do not have to be identical in the two settings, quality services appropriate for the needs of rural communities are imperative. Moreover, health education and promotion should be seen as an immediate and viable strategy for (a) reducing risk factors and health care needs, and (b) increasing the cost effectiveness of existing services. The appropriateness and prioritization of health care services and health education/promotion can only be realized if health professionals are aware of rural versus urban needs. To facilitate our knowledge of such differences, the mortality rates of the 10 leading causes of death were compared for each county in Ohio and differences between rural and urban mortality were analyzed. Counties were categorized according to "density" (persons per square mile) and "percent urban" (percent of county area classified as urban). The analysis demonstrated that there were no significant differences between rural and urban counties in mortality due to cancer, pulmonary disease, diabetes mellitus, atherosclerosis, and suicide. Mortality related to cardiovascular disease, cerebrovascular disease, accidents, and influenza/pneumonia was significantly higher in rural counties, while deaths due to chronic liver disease were significantly greater in urban counties.

High obesity incidence in northern Sweden: How will Sweden look by 2009?

“…Our data are unusual in their ability to allow comparison of information from two geographically distinct, but rural areas of the developed world. Both regions have economies that have traditionally been based on farming, sustain long winters, were experiencing economic recession, and have lower socioeconomic indicators than other areas of their respective countries [19][20][21]. Previously published data show that obesity has a higher prevalence in rural (compared to urban) areas [19,22], but few other studies have compared rural areas to each other.…”

“…Both regions have economies that have traditionally been based on farming, sustain long winters, were experiencing economic recession, and have lower socioeconomic indicators than other areas of their respective countries [19][20][21]. Previously published data show that obesity has a higher prevalence in rural (compared to urban) areas [19,22], but few other studies have compared rural areas to each other. In addition, the ability to evaluate the same individuals after a 10-year interval makes this study particularly strong because we are able to calculate incidence rates.…”

United States rural hospital quality in the Hospital Compare database—Accounting for hospital characteristics

“…More often than not, the available data suggests that rural patients receive poorer care than their urban counterparts [8][9][10][11][12][13][14][15][16][17][18][19][20]. Unfortunately, most of this research is limited by using data from a single state or region [8,[11][12][13][14]17], including only a small number of hospitals [18], addressing only a single medical condition [10,12,15,[17][18][19][20][21][22] or patients covered by single payer (such as Medicare) [10,14,[17][18][19]22]. In addition, the few studies that have compared mortality rates for rural and urban hospitals are limited by difficulties in achieving adequate risk adjustment, since there are health status differences between rural and urban populations that may not be captured on routine administrative data [10,11] Others studies use data from 1980s or 1990s that may not be relevant to the current performance [10,11,14,18,21].…”

“…Unfortunately, most of this research is limited by using data from a single state or region [8,[11][12][13][14]17], including only a small number of hospitals [18], addressing only a single medical condition [10,12,15,[17][18][19][20][21][22] or patients covered by single payer (such as Medicare) [10,14,[17][18][19]22]. In addition, the few studies that have compared mortality rates for rural and urban hospitals are limited by difficulties in achieving adequate risk adjustment, since there are health status differences between rural and urban populations that may not be captured on routine administrative data [10,11] Others studies use data from 1980s or 1990s that may not be relevant to the current performance [10,11,14,18,21]. Finally, a recent national study comparing rural and urban hospital performance on processes of care did not considered whether performance differences are due simply to the volume of patients seen at the medical center or other hospital characteristics known to be associated with quality [23].…”

The Relationships Among Gender, Perceived Financial Barriers to Care, and Health Status in a Rural Population

“…Psychological well being was studied by Kernoff, Preston, and Crawford (1988), with greater stressors from poverty and child rearing noted in the rural women in their sample. rural midwestern populations (Schorr, Crabtree, Wagner, & Wetterau, 1989); black and white rural women were found to incur more cardiac risk than their urban counterparts (Edwards, Parker, Burks, West, & Adams, 1991). Financial barriers to recommended cancer screenings such as Pap smears and mammography were found in a rural sample by Spurlock, Nadel, and McMannon (1992).…”