The rural-urban gap in mortality had been growing steadily over the last three decades, and a growing body of work had looked into the reasons for this growing disparity, specifically the causes of deaths. Another approach was to build on the seminal work that mapped lifestyle and behavior factors into death rates from specific causes; that is, to make predictions of future death rates due to current behavior. We hypothesized that the generally poorer health behaviors in rural areas lead to higher rates of avoidable death rural communities than in urban communities.

A deeper understanding of the relationship between behaviors and mortality may influence policy priorities. It may be the case that the most efficient strategies for targeting the overall rural-urban mortality rate are based in factors more "upstream" than previously thought. For example, while deaths from trauma (especially for those who had poor access to timely high-quality trauma care) may grab headlines, the less visible deaths from lung cancer (as a result of higher smoking rates) and heart disease (as a result of obesity) may disproportionately be more responsible for the rural-urban disparity.

The goals of the study were to:

1. Determine whether the rate of avoidable deaths is equal in rural and urban communities in the United States.
2. Examine whether and how this pattern varies by region (e.g., in the South) and rural definition (e.g., micropolitan vs noncore).
3. Characterize the relative contribution of the key behaviors (e.g., the effect of smoothing relative to the effect of excessive alcohol use).

Publications

• Risk Factors and Potentially Preventable Deaths in Rural Communities
  Policy Brief
  North Carolina Rural Health Research and Policy Analysis Center
  Date: 10/2019
  In this study, we use variation in three risk factors – smoking, obesity, and excessive alcohol use – to identify their relative contribution to common causes of mortality.