Rural and Urban Differences in Mortality Among Americans 55 Years and Older: Analysis of the National Longitudinal Mortality Study

Abstract

Previous research on rural and urban differences in risk of mortality has been inconclusive. This article used data from the National Longitudinal Mortality Study to establish whether all-cause mortality risk among persons 55 years and older varies by degree of urbanization, controlling for the potential sociodemographic confounders of age, gender, race/ethnicity, education, income, and marital status. Using the Cox Proportional Hazards Regression Procedure, the authors found that persons living in the most rural locales and those living in rural communities in standard metropolitan statistical areas (SMSAs) have the lowest risk of mortality, while those living in SMSA central cities had the highest risk of dying during the study period. The protective effect of rural residence declines in older age cohorts.

Rural versus Urban Environments

“…We are investigating this possibility in a separate analysis. Our preliminary findings are not supportive of the "artifact" explanation for urban dwellers" (Smith et al 1995). In rural areas, roads are more poorly maintained, vehicular accidents more prevalent, and emergency services are slower to respond (Wright 1985), pointing to an urban advantage in these areas.…”

“…In rural areas, roads are more poorly maintained, vehicular accidents more prevalent, and emergency services are slower to respond (Wright 1985), pointing to an urban advantage in these areas. Smith et al (1995) also observe that the range of services available in rural areas are fewer in terms of both health care facilities and health care providers.…”

“…Findings by Smith et al (1995) conclude that people living in rural settings are "more likely to be married and least likely to be widowed, divorced, or separated when contrasted with those living in central cities." Marriage can be an important form of social support.…”

“…Pendleton and Chang (1979) conclude, "In general, there is greater per capita medical care available to urban populations." Rural areas have fewer hospital beds, doctors, nurses, and specialists per capita than more urban areas (Smith et al 1995). Owing to geographic isolation and decreased population per square mile, traveling long distances for health care services may be much more common among rural than urban dwellers.…”

Is Sprawl Associated with a Widening Urban–Suburban Mortality Gap?

“…Smith et al and Hayward et al focused on a population of men 55 years or older and found that excess mortality existed among urban residents even after controlling for differences in social class and lifestyle factors between urban and suburban residents. 12,13 Although the aforementioned studies performed adjustments for population composition and socioeconomic status, no study has yet examined how the extent of urban-suburban health disparities in a metropolitan area may be influenced by the region's built environment. The built environment, encompassing all of the buildings, spaces, and products that are created or significantly modified by people, not only forms a backcloth against which people live, work, and play, 14 but also to some degree determines residents' exposure to environmental risks and the associated physiological and psychosocial impacts.…”