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Back in the late 1990s, a distressing trend took hold for rural
America. At that time, rural and urban mortality rates started
to diverge, with rural populations experiencing 9% higher
mortality in working-age adults. Unfortunately, the divide has
only grown over time. As of 2019, working-age adults in rural
areas were 43% more likely to die from natural causes than their
urban counterparts, but researchers have struggled to explain
this gap.
In a first-of-its-kind study, University of Illinois
Urbana-Champaign and USDA Economic Research Service researchers
help explain the rural mortality disadvantage by combining a
place-based analysis with health biomarkers from over 66,000
people across a 20-year span.
“We find that chronic stress, nicotine use, obesity, and diet
are major factors likely contributing to the growth of the
rural-urban mortality gap,” said study author Sarah Low,
professor and head of the Department of Agricultural and
Consumer Economics, part of the College of Agricultural,
Consumer and Environmental Sciences at Illinois. “But we find
that the rural-urban gaps are really disparities associated with
place, rather than as causal effects of rural residence.”
Low and her co-authors leveraged the National Health and
Nutrition Examination Survey, a nationally representative survey
administered annually, which gave them access to anonymized
blood biomarkers, records of physical exams, and county of
residence.
The research team analyzed health measures based on whether
individuals lived in large metropolitan, small/medium
metropolitan, or nonmetropolitan (rural) counties.
“We found rural health disadvantages exist across the overall
adult and prime working-age (25-54) populations and are likely
linked to the growing gap between urban and rural natural cause
mortality rates documented by USDA,” Low said. “Specifically,
chronic stress appears to be contributing to rural-urban health
gaps.”
Chronic stress is manifested in a cardiometabolic index that
measures metabolic health with blood pressure, cholesterol,
pulse rate, diabetes, and obesity, and, in this study, serves as
a proxy for allostatic load (i.e., the wear and tear on an
individual’s organs over time).
“These metrics are a combination of factors we got from the
survey, such as whether an individual is diabetic, has cotinine
in their blood (evidence of nicotine use), high blood pressure,
just a whole host of things,” Low explained. “The more of those
things you have, the higher the cardiometabolic index and the
higher the overall stress on the body.”
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Low says there are various factors that could increase chronic
stress among working-age adults in rural America. Farming is an
inherently stressful occupation, and the rural nonfarm economy
has struggled since the U.S. manufacturing crisis began in the
late 1990s. Working-age adults in rural areas are also more
likely to be caring for children and elderly parents.
Combining individual health metrics like the cardiometabolic
index, health behaviors like smoking, and place-based data like
access to full-service grocery stores, hospitals, or gyms is
what makes the study unique.
“It's this wicked mess to untangle,” Low said. “But the data
told us we can’t blame rural-urban health disparities on
rurality alone. By digging into the data, we found that it is
the characteristics of rural communities rather than the fact
that they are rural that is driving the place-based results.”
Low says this nuance points to gaps in healthcare access,
healthy food options, gyms, and other amenities in certain rural
areas compared to urban areas.
“Our results can help inform policies and programs aimed at
improving rural health and rural workforce productivity, which
both impact the rural economy,” Low said. “Communities with
workforce shortages may consider how improving the food
environment and health behaviors might improve health outcomes.
For example, educational programming to improve diets, decrease
obesity, and eliminate cigarette use may have tangible effects
on rural health outcomes.”
[Lauren Quinn | ACES News]
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