Nathan Hale1, Kate Beatty1, Michael Smith1. 1. Department of Health Services Management & Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee.
Abstract
PURPOSE: Rural communities often experience higher rates of mortality than their urban counterparts, with gaps widening in the foreseeable future. However, the underlying level of socioeconomic vulnerability (area deprivation) among rural communities can vary widely. This study examines rural-urban differences in mortality-related outcomes within comparable levels of deprivation. METHODS: Rural-urban differences in Years of Potential Life Lost (YPLL), derived from the County Health Rankings, were examined across comparable levels of area deprivation using a quantile regression approach. Rural-urban differences in YPLL were estimated at the 10th, 25th, 50th, 75th, and 90th percentiles across levels of deprivation. FINDINGS: Compared to the reference population (urban counties/least deprived) a clear increase in YPLL among both rural and urban counties was noted across levels of deprivation, with the highest level of YPLL occurring in counties with the most deprivation. While YPLL increased across levels of deprivation, the magnitude of these differences was markedly higher in rural counties compared to urban, particularly among the most deprived counties. Rural counties experienced an advantage at the lowest percentiles and levels of deprivation. However, this advantage quickly deteriorated, revealing significant rural disparities at the highest level of deprivation. CONCLUSIONS: This study noted a differential effect in mortality-related outcomes among rural counties within comparable levels of community deprivation. Findings contribute to evidence that many, but not all rural communities face a double disadvantage. This underscores the need for a continued focus on the development and implementation of multiple policies aimed at reducing differences in poverty, education, and access to care.
PURPOSE: Rural communities often experience higher rates of mortality than their urban counterparts, with gaps widening in the foreseeable future. However, the underlying level of socioeconomic vulnerability (area deprivation) among rural communities can vary widely. This study examines rural-urban differences in mortality-related outcomes within comparable levels of deprivation. METHODS: Rural-urban differences in Years of Potential Life Lost (YPLL), derived from the County Health Rankings, were examined across comparable levels of area deprivation using a quantile regression approach. Rural-urban differences in YPLL were estimated at the 10th, 25th, 50th, 75th, and 90th percentiles across levels of deprivation. FINDINGS: Compared to the reference population (urban counties/least deprived) a clear increase in YPLL among both rural and urban counties was noted across levels of deprivation, with the highest level of YPLL occurring in counties with the most deprivation. While YPLL increased across levels of deprivation, the magnitude of these differences was markedly higher in rural counties compared to urban, particularly among the most deprived counties. Rural counties experienced an advantage at the lowest percentiles and levels of deprivation. However, this advantage quickly deteriorated, revealing significant rural disparities at the highest level of deprivation. CONCLUSIONS: This study noted a differential effect in mortality-related outcomes among rural counties within comparable levels of community deprivation. Findings contribute to evidence that many, but not all rural communities face a double disadvantage. This underscores the need for a continued focus on the development and implementation of multiple policies aimed at reducing differences in poverty, education, and access to care.