Widening rural-urban disparities in all-cause mortality and mortality from major causes of death in the USA, 1969-2009

Gopal K. Singh, Mohammad Siahpush

Research output: Contribution to journalReview article

95 Citations (Scopus)

Abstract

This study examined trends in rural-urban disparities in all-cause and cause-specific mortality in the USA between 1969 and 2009. A rural-urban continuum measure was linked to county-level mortality data. Age-adjusted death rates were calculated by sex, race, cause-of-death, area-poverty, and urbanization level for 13 time periods between 1969 and 2009. Cause-of-death decomposition and log-linear and Poisson regression were used to analyze rural-urban differentials. Mortality rates increased with increasing levels of rurality overall and for non-Hispanic whites, blacks, and American Indians/Alaska Natives. Despite the declining mortality trends, mortality risks for both males and females and for blacks and whites have been increasingly higher in non-metropolitan than metropolitan areas, particularly since 1990. In 2005-2009, mortality rates varied from 391.9 per 100,000 population for Asians/Pacific Islanders in rural areas to 1,063.2 for blacks in small-urban towns. Poverty gradients were steeper in rural areas, which maintained higher mortality than urban areas after adjustment for poverty level. Poor blacks in non-metropolitan areas experienced two to three times higher all-cause and premature mortality risks than affluent blacks and whites in metropolitan areas. Disparities widened over time; excess mortality from all causes combined and from several major causes of death in non-metropolitan areas was greater in 2005-2009 than in 1990-1992. Causes of death contributing most to the increasing rural-urban disparity and higher rural mortality include heart disease, unintentional injuries, COPD, lung cancer, stroke, suicide, diabetes, nephritis, pneumonia/influenza, cirrhosis, and Alzheimer's disease. Residents in metropolitan areas experienced larger mortality reductions during the past four decades than non-metropolitan residents, contributing to the widening gap.

Original languageEnglish (US)
Pages (from-to)272-292
Number of pages21
JournalJournal of Urban Health
Volume91
Issue number2
DOIs
StatePublished - Jan 1 2014

Fingerprint

cause of death
Cause of Death
mortality
cause
Mortality
agglomeration area
poverty
Poverty
rural area
resident
Poverty Areas
Urbanization
Premature Mortality
North American Indians
Nephritis
death rate
American Indian
heart disease
trend
stroke

Keywords

  • Cause of death
  • Decomposition
  • Inequality
  • Metropolitan
  • Mortality
  • Poverty
  • Race
  • Rural-urban
  • Trend
  • USA

ASJC Scopus subject areas

  • Health(social science)
  • Urban Studies
  • Public Health, Environmental and Occupational Health

Cite this

Widening rural-urban disparities in all-cause mortality and mortality from major causes of death in the USA, 1969-2009. / Singh, Gopal K.; Siahpush, Mohammad.

In: Journal of Urban Health, Vol. 91, No. 2, 01.01.2014, p. 272-292.

Research output: Contribution to journalReview article

@article{42ad33f270fd4235a04f672237598d43,
title = "Widening rural-urban disparities in all-cause mortality and mortality from major causes of death in the USA, 1969-2009",
abstract = "This study examined trends in rural-urban disparities in all-cause and cause-specific mortality in the USA between 1969 and 2009. A rural-urban continuum measure was linked to county-level mortality data. Age-adjusted death rates were calculated by sex, race, cause-of-death, area-poverty, and urbanization level for 13 time periods between 1969 and 2009. Cause-of-death decomposition and log-linear and Poisson regression were used to analyze rural-urban differentials. Mortality rates increased with increasing levels of rurality overall and for non-Hispanic whites, blacks, and American Indians/Alaska Natives. Despite the declining mortality trends, mortality risks for both males and females and for blacks and whites have been increasingly higher in non-metropolitan than metropolitan areas, particularly since 1990. In 2005-2009, mortality rates varied from 391.9 per 100,000 population for Asians/Pacific Islanders in rural areas to 1,063.2 for blacks in small-urban towns. Poverty gradients were steeper in rural areas, which maintained higher mortality than urban areas after adjustment for poverty level. Poor blacks in non-metropolitan areas experienced two to three times higher all-cause and premature mortality risks than affluent blacks and whites in metropolitan areas. Disparities widened over time; excess mortality from all causes combined and from several major causes of death in non-metropolitan areas was greater in 2005-2009 than in 1990-1992. Causes of death contributing most to the increasing rural-urban disparity and higher rural mortality include heart disease, unintentional injuries, COPD, lung cancer, stroke, suicide, diabetes, nephritis, pneumonia/influenza, cirrhosis, and Alzheimer's disease. Residents in metropolitan areas experienced larger mortality reductions during the past four decades than non-metropolitan residents, contributing to the widening gap.",
keywords = "Cause of death, Decomposition, Inequality, Metropolitan, Mortality, Poverty, Race, Rural-urban, Trend, USA",
author = "Singh, {Gopal K.} and Mohammad Siahpush",
year = "2014",
month = "1",
day = "1",
doi = "10.1007/s11524-013-9847-2",
language = "English (US)",
volume = "91",
pages = "272--292",
journal = "Journal of Urban Health",
issn = "1099-3460",
publisher = "Springer Science and Business Media Deutschland GmbH",
number = "2",

}

TY - JOUR

T1 - Widening rural-urban disparities in all-cause mortality and mortality from major causes of death in the USA, 1969-2009

AU - Singh, Gopal K.

AU - Siahpush, Mohammad

PY - 2014/1/1

Y1 - 2014/1/1

N2 - This study examined trends in rural-urban disparities in all-cause and cause-specific mortality in the USA between 1969 and 2009. A rural-urban continuum measure was linked to county-level mortality data. Age-adjusted death rates were calculated by sex, race, cause-of-death, area-poverty, and urbanization level for 13 time periods between 1969 and 2009. Cause-of-death decomposition and log-linear and Poisson regression were used to analyze rural-urban differentials. Mortality rates increased with increasing levels of rurality overall and for non-Hispanic whites, blacks, and American Indians/Alaska Natives. Despite the declining mortality trends, mortality risks for both males and females and for blacks and whites have been increasingly higher in non-metropolitan than metropolitan areas, particularly since 1990. In 2005-2009, mortality rates varied from 391.9 per 100,000 population for Asians/Pacific Islanders in rural areas to 1,063.2 for blacks in small-urban towns. Poverty gradients were steeper in rural areas, which maintained higher mortality than urban areas after adjustment for poverty level. Poor blacks in non-metropolitan areas experienced two to three times higher all-cause and premature mortality risks than affluent blacks and whites in metropolitan areas. Disparities widened over time; excess mortality from all causes combined and from several major causes of death in non-metropolitan areas was greater in 2005-2009 than in 1990-1992. Causes of death contributing most to the increasing rural-urban disparity and higher rural mortality include heart disease, unintentional injuries, COPD, lung cancer, stroke, suicide, diabetes, nephritis, pneumonia/influenza, cirrhosis, and Alzheimer's disease. Residents in metropolitan areas experienced larger mortality reductions during the past four decades than non-metropolitan residents, contributing to the widening gap.

AB - This study examined trends in rural-urban disparities in all-cause and cause-specific mortality in the USA between 1969 and 2009. A rural-urban continuum measure was linked to county-level mortality data. Age-adjusted death rates were calculated by sex, race, cause-of-death, area-poverty, and urbanization level for 13 time periods between 1969 and 2009. Cause-of-death decomposition and log-linear and Poisson regression were used to analyze rural-urban differentials. Mortality rates increased with increasing levels of rurality overall and for non-Hispanic whites, blacks, and American Indians/Alaska Natives. Despite the declining mortality trends, mortality risks for both males and females and for blacks and whites have been increasingly higher in non-metropolitan than metropolitan areas, particularly since 1990. In 2005-2009, mortality rates varied from 391.9 per 100,000 population for Asians/Pacific Islanders in rural areas to 1,063.2 for blacks in small-urban towns. Poverty gradients were steeper in rural areas, which maintained higher mortality than urban areas after adjustment for poverty level. Poor blacks in non-metropolitan areas experienced two to three times higher all-cause and premature mortality risks than affluent blacks and whites in metropolitan areas. Disparities widened over time; excess mortality from all causes combined and from several major causes of death in non-metropolitan areas was greater in 2005-2009 than in 1990-1992. Causes of death contributing most to the increasing rural-urban disparity and higher rural mortality include heart disease, unintentional injuries, COPD, lung cancer, stroke, suicide, diabetes, nephritis, pneumonia/influenza, cirrhosis, and Alzheimer's disease. Residents in metropolitan areas experienced larger mortality reductions during the past four decades than non-metropolitan residents, contributing to the widening gap.

KW - Cause of death

KW - Decomposition

KW - Inequality

KW - Metropolitan

KW - Mortality

KW - Poverty

KW - Race

KW - Rural-urban

KW - Trend

KW - USA

UR - http://www.scopus.com/inward/record.url?scp=84898807627&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84898807627&partnerID=8YFLogxK

U2 - 10.1007/s11524-013-9847-2

DO - 10.1007/s11524-013-9847-2

M3 - Review article

C2 - 24366854

AN - SCOPUS:84898807627

VL - 91

SP - 272

EP - 292

JO - Journal of Urban Health

JF - Journal of Urban Health

SN - 1099-3460

IS - 2

ER -