Researchers have long found that general mortality estimates for whites and African Americans have consistently shown that black death rates exceed white rates. However, there is limited information on historical trends in mortality rates between older black and white adults living in urban societies compared with rural communities.
A paper recently published in the Journal of the American Medical Association (JAMA) assesses older adults living in rural vs. urban counties and the role racial disparities play in mortality rates. Nationally representative data was collected from 3,131 U.S. counties between 1968-2016, and the researchers looked at three types of regions: urban counties, rural counties adjacent to an urban county and rural counties not adjacent to an urban county.
“This study indicates that the mortality differences among older black and white adults have narrowed in the urban areas; however, there is considerable widening in mortality rates among black and white men living in rural and suburban areas,” said Amit Kumar, assistant professor in the Department of Physical Therapy at Northern Arizona University and a senior author on the paper. “Notably, the current mortality rate of black men living in rural areas is like that of white men living in urban and rural areas in the mid-1980s.”
Why is the racial gap widening between rural and urban America?
Kumar thinks there is some level of health care disparity and bias in health care delivery, which restricts rural residents from optimizing their health outcomes. In addition to the long-lasting shortage of physicians in rural areas, an disproportionate number of rural hospitals and nursing homes have closed in the last 10 years. This makes health care harder and more expensive for people living in these areas to access.
“Individuals with stroke require post-acute inpatient rehabilitation care more regularly compared to others. Living in rural areas makes it difficult for them to access the care they need,” he said. “African Americans have a higher risk of stroke. Because of lower access to post-acute inpatient rehabilitation services in rural areas, African Americans living in rural areas are at higher risk.”
Study coauthor Julie A. Baldwin, Regents’ professor of health sciences and director of the Center for Health Equity Research and PI of the Southwest Health Equity Research Collaborative (SHERC), said the findings concern her, both because of how little progress has been made up to now but also because of what they could mean for the future of rural America.
“The results are disturbing because the gap appears to be widening after accounting for socioeconomic characteristics,” she said. “Moreover, the evidence suggests that we are not making progress in reducing the gap even 17 years after the Institute of Medicine’s Report, ‘Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care,’ was published. This report demonstrated that people of color are less likely to receive preventive care than whites and often receive lower-quality care in the U.S.”