Socioeconomic variables explain rural disparities in US mortality rates: Implications for rural health research and policy

Long, Alexander S.; Hanlon, Alexandra L.; Pellegrin, Karen L.

doi:10.1016/j.ssmph.2018.08.009

Cited by 84 publications

(57 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Growing rural–urban and within-rural disparities may reflect increasing inequities in any number of upstream social-structural factors, including educational attainment, which is becoming an increasingly important determinant of morality disparities (Hayward et al 2015 ); as well as material resources, opportunities for employment and upward mobility, social capital and integration (Yang et al 2011 ); housing quality, environmental quality, and the distribution of economic, educational, and/or social resources. In a study that covered 2004–2012, Long et al ( 2018 ) found that median income and percent poverty explained nearly all of the rural mortality disadvantage and argued that interventions targeting social determinants of health in rural areas must be prioritized. Importantly, all of these factors are influenced by politics and policy decisions at the national, state, and local levels.…”

Section: Discussionmentioning

confidence: 99%

Trends in U.S. Working-Age non-Hispanic White Mortality: Rural–Urban and Within-Rural Differences

Monnat

2020

Popul Res Policy Rev

View full text Add to dashboard Cite

After decades of lower or comparable mortality rates in rural than in urban areas of the U.S., numerous studies have documented a rural mortality penalty that started in the 1990s and has grown since the mid-2000s. The widening of the gap appears to be especially pronounced among non-Hispanic (NH) whites. However, the rural U.S. is not monolithic, and some rural places have experienced much larger mortality rate increases than others over the past 30 years. Drawing on restricted mortality files from the National Vital Statistics System (NVSS), I examine metro versus nonmetro and intra-nonmetro (divisional and economic dependency) all-cause and cause-specific mortality trends among working-age (25-64) NH white males and females, 1990-2018. Results show that the nonmetro mortality penalty is wide and growing and is pervasive across multiple disease and injury categories. Trends for females are particularly concerning. Smaller nonmetro declines in mortality from cancers and cardiovascular disease (throughout the 1990s and 2000s) and larger increases in metabolic and respiratory diseases, suicide, alcohol-related, and mental/behavioral disorders (throughout the 2010s) collectively drove the growth in the nonmetro disadvantage. There are also large divisional disparities (which are growing for females), with particularly poor trends in New England, South Atlantic, ES Central, WS Central, and Appalachia and more favorable trends in the Mid-Atlantic, Mountain, and Pacific. Mining-dependent counties have diverged from the other economic dependency types since the mid-2000s due to multiple causes of death, whereas farming counties have comparatively lower mortality rates. High and rising mortality rates across a variety of causes and rural places, some of which have been occurring since the 1990s and others that emerged more recently, suggest that there is not one underlying explanation. Instead, systemic failures across a variety of institutions and policies have contributed to rural America's troubling mortality trends generally and within-rural disparities more specifically.

show abstract

Section: Discussionmentioning

confidence: 99%

Trends in U.S. Working-Age non-Hispanic White Mortality: Rural–Urban and Within-Rural Differences

Monnat

2020

Popul Res Policy Rev

View full text Add to dashboard Cite

show abstract

“…Although we found no significant difference between rural and urban cancer survivors for health status, previous studies have shown substantial rural-urban differences in health status outcomes. A small rural sample size may have limited our power to detect statistically significant differences and limited our ability to complete stratified analyses by cancer type or socioeconomic status, which may help explain disparities in PA and health status [3,24,25]. However, it is important to highlight that 24.3% and 18.9% of cancer survivors in this study reported their physical and mental health, respectively, as 'not good' for one week or more in the past month, regardless of rural-urban residence.…”

Section: Discussionmentioning

confidence: 99%

Rural-urban differences in meeting physical activity recommendations and health status in cancer survivors in central Pennsylvania

Mama

Bhuiyan

Foo

et al. 2020

Support Care Cancer

View full text Add to dashboard Cite

Background: This study explored rural-urban differences in meeting physical activity (PA) recommendations and health status in cancer survivors in central Pennsylvania and associations between PA and health status. Methods: Cancer survivors (N=2,463) were identified through a state cancer registry and mailed questionnaires assessing PA and health status. Rural-urban residence was based on county of residence at diagnosis. Participants self-reported frequency and duration of leisure-time PA and were classified as: 1) meeting aerobic recommendations (≥150 minutes/week), 2) muscle-strengthening recommendations (≥2 times/week), 3) both aerobic and muscle-strengthening recommendations, or 4) neither recommendation. Logistic regression models examined associations between rural-urban residence and meeting PA recommendations and associations between PA and health status, adjusting for cancer type, gender and income. Results: Nearly 600 (N=591, 24.0%) cancer survivors returned completed questionnaires (rural 9.5%, urban 90.5%). Half (50.0%) of rural cancer survivors reported no leisure-time PA compared to 35.2% of urban cancer survivors (p=.020), and urban cancer survivors were 2.6 times more likely to meet aerobic PA recommendations (95% CI: 1.1-6.4). Odds of reporting good physical and mental health were 2.3 times higher among survivors who reported meeting aerobic recommendations compared to those who did not meet PA recommendations (95% CI: 1.1-4.5), adjusting for rurality and covariates. Conclusions: Results demonstrate persistent rural-urban differences in meeting PA recommendations in cancer survivors and its association with self-reported health. These findings underscore the need for interventions to increase PA in rural cancer survivors in an effort to improve health status and reduce cancer health disparities in this population. dichotomized poor physical health days (≥7 days vs. <7 days), poor mental health days (≥7 days vs. <7 days), and poor physical or mental health days impeding activities (≥7 days vs. <7 days). Regression analyses included cancer type, gender, and income because they were associated with PA and rural-urban residence. Effect modification by rural-urban differences was assessed. Results Participant Characteristics Of the 2,463 cancer survivors mailed recruitment letters and questionnaires, 591 (24.0%) returned completed questionnaires and participated in this study (Figure 1); the response rate did not significantly differ between rural (19.8%) and urban (24.5%) cancer survivors (χ 2 =3.1, p=.078). Breast cancer survivors were most likely to return completed questionnaires, followed by gynecologic, prostate, and colorectal cancer survivors; lung cancer survivors were least likely to participate. Demographic characteristics, PA, and health status are summarized in Table 1 by rural-urban residence. Rural cancer survivors were significantly more likely to be unemployed (χ 2 =4.9, p=.025) than urban cancer survivors. Half (50.0%) of rural cancer survivors reported being physically inactive (re...

show abstract

“…Language barriers have the potential to increase the risk to Spanish-speaking populations who cannot understand the public health messages or who are unable to communicate with providers or testing centers (Macias Gil et al 2020). In rural communities, this may be exacerbated by decreased access to care, unstable internet capabilities, and decreased transportation options (Long, Hanlon, and Pellegrin 2018), and isolation may increase the difficulty accessing accurate information, especially in the presence of language barriers (Macias Gil et al 2020).…”

Section: Introductionmentioning

confidence: 99%

Exploring a rural Latino community’s perception of the COVID-19 pandemic

et al. 2020

View full text Add to dashboard Cite

Objectives: The purpose of our study was to understand the perception of the Latino community in a rural state regarding COVID-19. Over one third of national COVID-19 cases are among Latinos, likely due to an increased prevalence of comorbid risk factors and social determinants of health that make following precautions difficult. Design: Respondents were recruited using snowball sampling as part of a previous effort to establish an academic-community partnership with Latinos in the area. In April 2020, we conducted 14 semi-structured interviews in Spanish with participants over the phone. Interviews were audio-recorded, transcribed into Spanish, and translated to English. We employed the framework approach in a thematic analysis using NVivo 12. Results: Common themes were a wariness of news appearing on social media, generalized worry, and the use of natural medicines to maintain health. Respondents followed recommended guidelines to protect their own health, though expressed concern that members of their community were not. Conclusions: We offer insights into the perception of Latinos of the COVID-19 pandemic in a rural state. Our findings may influence communication techniques of local health departments and offer a way to understand how this often-overlooked community deals with the pandemic.

show abstract

Socioeconomic variables explain rural disparities in US mortality rates: Implications for rural health research and policy

Cited by 84 publications

References 24 publications

Trends in U.S. Working-Age non-Hispanic White Mortality: Rural–Urban and Within-Rural Differences

Trends in U.S. Working-Age non-Hispanic White Mortality: Rural–Urban and Within-Rural Differences

Rural-urban differences in meeting physical activity recommendations and health status in cancer survivors in central Pennsylvania

Exploring a rural Latino community’s perception of the COVID-19 pandemic

Contact Info

Product

Resources

About