Though U.S. life expectancy has increased during the last 50 years, this benefit has not been geographically uniform, and certain rural persons and communities face a mortality gap. Rural residents experience a shorter life expectancy than urban residents, with higher mortality rates from specific causes such as chronic obstructive pulmonary diseases, coronary heart disease, and lung cancer. Overall, there are higher mortality rates among rural residents for all five leading causes of death – heart disease, stroke, cancer, unintentional injury, and chronic lower respiratory disease – as compared to urban residents.

We sought to close gaps in our understanding of the rural-urban mortality disparity by conducting a time-to-event cohort analysis using the National Health Interview Survey linked to national death certificate data. We found the risk of death at any point in time was 10% higher for rural as compared with urban residents and increased over time. Also, leading causes of death and rural-urban differences shifted between birth cohorts. Our findings generally suggest that the overall mortality penalty in rural areas between 1997 and 2011 may have been driven by social determinants of health. The findings from our study may help to identify potential policy and practice interventions that may reduce the rural-urban mortality gap and lead to longer, healthier lives for rural populations.