Since the 1980s, the all-cause mortality rate in the U.S for rural residents has exceeded that of urban dwellers. In a recently completed study, researchers from the F. Marie Hall Institute for Rural and Community Health at the Texas Tech University Health Sciences Center sought to determine why this disparity exists in general -- and specifically why this imbalance varies so much between states.
The results from their study, "Higher U.S. Rural Mortality Rates Linked To Socioeconomic Status, Physician Shortages, And Lack Of Health Insurance," was published in Health Affairs.
Dr. Gordon Gong, an associate professor of rural and community health who recently retired from TTUHSC, authored the study. Scott Phillips, editor in chief for TTUHSC's Rural Health Quarterly magazine and a co-author to the study, presented the results recently at the Health Affairs Rural Health Forum hosted by the National Press Club in Washington D.C.
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Phillips said the study spun off of a U.S. rural health report card that he, Gong and others have been putting together since 2016. They started the report card by trying to answer one question: How well does Texas stack up to other states when it comes to providing quality rural health care?
They couldn't answer the question. And they found that no one else had really tried to.
WHAT'S THE IMPACT
The study focused on five explanatory variables within each county: socioeconomic deprivation (e.g., poverty status, access to housing and education, employment), uninsured rates, the supply of and access to primary care physicians, the percentage of racial or ethnic groups and the number of rural and urban residents.
But after compiling all of the data, the TTUHSC researchers discovered that only three of their explanatory variables were applicable: socioeconomic deprivation, percentage of uninsured and the primary care physician supply. Those three variables accounted for 81.8% of the total variance of mortality.
In the end the remaining variables were not significantly associated with mortality.
The race-ethnicity variable initially indicated that the percentage of African Americans is positively associated with mortality. However, after adjustments for socioeconomic deprivation, uninsured rates and supply-access to primary care physicians were factored in, that finding was reversed. In other words, African Americans have higher rates of mortality, but it's due to other disparities they face, such as socioeconomic status and access to care.
The study also showed the percentage of Hispanic Americans is negatively associated with mortality. That could be attributed to what is known as the Hispanic paradox, an accepted epidemiological finding that Hispanic Americans tend to have health outcomes that are comparable to, and often better than those of non-Hispanic whites, even though Hispanic Americans on average tend to have lower socioeconomic status.
This implies that rural residency in and of itself does not appear to negatively affect mortality. Instead, the study suggests that rural residency tends to favor lower mortality.
Armed with the information from the study, the TTUHSC team now wants to analyze the three states that proved to be exceptions to those findings: Colorado, Montana and Wyoming.
THE LARGER TREND
Residents of rural areas are more likely to be hospitalized and to die than those who live in cities primarily because they lack access to specialists, recent research found.
A paper published in December found that Medicare recipients with chronic conditions such as heart failure or diabetes who live in rural locations have higher death and hospitalization rates than those living in more urban settings. Lack of access to specialists, such as cardiologists and endocrinologists, was the primary reason.
Meanwhile, about 430 rural hospitals are at risk of closing, the National Bureau of Economic Research found in September -- and that's on top of 113 that have already closed since 2010. Remote areas in California have been hit especially hard, and that's where most of the research was focused; the state lost 92 rural hospitals from 1995 to 2011.
Urban hospitals have closed as well, but the data shows there were no immediate impacts to the health of the surrounding populations. Because access to health services can be an issue in rural locales, rural hospital closings had a much more profound impact, with mortality rates rising to 5.9%.