Sarah H. Cross, Ph.D., M.P.H., from the Sanford School of Public Policy at Duke University in Durham, North Carolina, and colleagues examined recent trends in rural-urban differences in age-adjusted mortality rates (AAMRs) in the United States. The AAMRs were calculated per 100,000 population and stratified by age, sex, and race/ethnicity, and the annual percentage change (APC) in AAMR was estimated.

The researchers found that rural areas had the highest AAMRs from 1999 to 2019. The overall AAMR decreased in large metropolitan areas (from 861.5 to 664.5/100,000) and in rural areas (923.8 to 834.0/100,000). There was an increase in the absolute difference in AAMRs between large metropolitan areas and rural areas, from 62.3 to 169.5/100,000 from 1999 to 2019, which was an increase of 172 percent. Declines were seen in AAMRs for all ages except for rural residents aged 25 to 64 years, who had an increase in AAMR from 1999 to 2019 (APC, 0.6 percent). Men had greater AAMRs than women across areas. The absolute difference in AAMRs between large metropolitan and rural areas increased for men and women from 1999 to 2019 (95.8 to 187.7/100,000 and 32.9 to 144.5/100,000, respectively).

"To reverse increasing rural-urban disparities, researchers, funders, and policy makers must understand the factors worsening rural health and design programs and policies accordingly," the authors write.

One author disclosed financial ties to the medical technology and biopharmaceutical industries.

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