by Jazmin Orozco Rodriguez
During his two years as director of vital statistics at the Arizona Department of Health Services, and 10 years earlier in the epidemiology program, Matthew Roach has seen mortality trends that concern local health professionals. Ta.
As Roach tracked the health of Arizonans, the gap between death rates for people living in rural areas and those in urban areas widened.
Health disparities between rural and urban Americans have long been documented; recent reports Researchers at the Department of Agriculture’s Economic Research Service found that this chasm has widened in recent decades. USDA researchers found that rural Americans between the ages of 25 and 54 die from natural causes such as chronic diseases and cancer at significantly higher rates than their urban counterparts. I discovered that. This analysis does not include external causes of death, such as suicide or accidental overdose.
The study analyzed two three-year periods of Centers for Disease Control and Prevention mortality data: 1999-2001 and 2017-2019. In 1999, the natural mortality rate for people aged 25 to 54 in rural areas was The mortality rate was only 6% higher than the mortality rate for 25- to 54-year-olds. For city dwellers in the same age group. By 2019, that gap had widened to 43%.
Researchers found that the widening gap is due to a rapid increase in the number of women living in rural areas who are losing their young lives to treatable or preventable diseases. In the most rural locations, i.e., counties without a core urban population of 10,000 or more, women in this age group experienced an 18% increase in natural mortality over the study period, compared to a 3% increase for their male peers. .
Cancer and heart disease are the leading causes of natural death among men and women of prime working age in both rural and urban areas. Among women, the incidence of lung disease increased the most in rural areas of the country compared to urban areas, followed by hepatitis. Pregnancy-related deaths also play a role, accounting for the highest increase in natural mortality among women aged 25-54 in rural areas.
Negative trends toward rural, non-Hispanic American Indians and Alaska Natives were particularly pronounced. The analysis found that the natural death rate for Native Americans between the ages of 25 and 54 increased by 46% over the past 20 years. Between the two time periods studied, mortality rates for Native women increased by an even greater 55%, while mortality rates for non-Hispanic white women increased by 23%.
Rural-urban disparities widened in all regions of the country, but were greatest in the South.
The study authors noted that increased mortality is an indicator of deteriorating national health and could have a negative impact on local economies and employment.
Rural health experts said the USDA findings should encourage stronger policies focused on rural health as access to and quality of health care services in rural areas continues to decline.
Alan Morgan, chief executive of the National Rural Health Association, said the report was “shocking” but “unfortunately not surprising”.
Morgan said this disparity needs more attention from state and national leaders.
Although the study did not address the causes of the increased mortality, the authors noted that differences in health care resources can undermine the accessibility, quality, and affordability of health care in rural areas. are doing. Hospitals in small, remote areas have long struggled; Continued closure or conversion Many places have limited medical services. The authors note that rates of poverty, disability, and chronic disease continue to be high in rural areas, exacerbated by fewer doctors per capita and hospital closures, impacting community health. There is.
Roach’s past work as an epidemiologist includes social vulnerability, which considers income, race, education, access to resources such as housing, etc. to understand a community’s resilience to adverse health impacts. He said it included a study of sex index. Looking at a map of Arizona, Rural counties and reservations Some vulnerability rankings are the highest.
Janice C. Probst, a retired professor at the University of South Carolina whose research focuses on rural health, says that much of today’s rural health efforts are focused on maintaining hospitals. He pointed out that it is an important source of medical care. But she says that may not be the best way to address inequality.
“We may need to take a community approach,” said Probst, who reviewed the report before publication. “The question is not how to maintain a hospital in a community, but how to maintain a community in the first place.”
For Probst, the disparity between demographics was just as noticeable as anything else. He said states with the highest natural mortality rates in rural areas include South Carolina, Mississippi, Georgia and Alabama, which have expanded Medicaid, a joint federal and state health insurance program for low-income people. states that have not. There is effort Due to expansion in some states; especially in mississippi.
This is an observation echoed by USDA researchers.
“Regional differences in state implementation of Medicaid expansion under the Affordable Care Act of 2010 can affect the frequency of medical care for at-risk populations, and the uninsured in states without expansion “This could increase the impact on local populations,” the researchers wrote.
Wesley James, founding executive director of the Center for Community Research and Evaluation at the University of Memphis, said the state Legislature could address some of the problem by advocating for Medicaid expansion within the state, which would allow rural areas to He said access to health care would increase. Many people want it, he said, but politicians aren’t listening to their needs. Mr. James also reviewed the report before it was published.
According to a KFF poll, two-thirds of the population lives in non-expansion states. I want them to expand their state. Health insurance program.
Morgan added that the study focused on deaths that occurred before the COVID-19 pandemic, which has had a devastating impact on rural areas.
“COVID-19 has profoundly changed the nature of public health in rural America,” he says. “This is an opportunity for Congress to direct the CDC to study life expectancy in rural and urban areas during and after the coronavirus pandemic to understand what the situation is really like across the country. hoping.”
Roach said coronavirus was the leading cause of death in Arizona in 2021 for people ages 45 to 64 in both rural and urban areas.
