Reducing health inequalities and increasing life expectancy in the United States have both been primary goals of the national health initiative, Healthy People 2020. Unfortunately, according to a new study in the American Journal of Preventive Medicine, over a 40-year period, rural residents have experienced smaller gains in life expectancy than their urban counterparts and the gap continues to grow.
"We've had information about life expectancy by gender, racial or ethnic and socioeconomic groups, but to our knowledge, nobody has looked at how disparities in life expectancy have changed over time—whether they're widening or narrowing," said the study's lead author Gopal K. Singh, Ph.D, of the U.S. Health Resources and Services Administration (HRSA). "In fact, disparities have been increasing over the past two decades as opposed to the last four."
Understanding the magnitude and causes of these disparities has implications for both public health planning and decision-making, Singh said, as rural residents "remain at a higher risk of mortality from major chronic conditions and injuries."
The study notes consistent overall increases in U.S. life expectancy during the past 40 years, from 70.8 years in 1970 to 78.7 years in 2010. In contrast, the study reveals the rural-urban gap widening from 0.4 years in 1969 to 1971 to 2.0 years in 2005 to 2009.
Accidents, cardiovascular disease, COPD and lung cancer accounted for 70 percent of the overall rural–urban gap in life expectancy and 54 percent of the life expectancy gap between the urban rich and rural poor in 2005 to 2009.
A number of factors likely explain the disparity, said SIngh. "When compared to urban areas, rural areas have higher rates of both smoking and lung cancer, along with obesity, yet reduced access to health care services. Additionally, rural residents have a lower median family income, higher poverty rate and fewer have college degrees.
17 percent of the U.S. population lives in rural areas, compared with 83 percent in urban areas, Singh noted. "There's always a temptation to take public health resources away from rural areas and focus on where people actively live, which would reduce the national disease burden but cause even greater rural–urban disparities in health and life expectancy."
"In public health, we tend to focus on overall life expectancy and it does move forward a little bit each year," said Steven P. Wallace, Ph.D., associate director of the UCLA Center for Health Policy Research and chair and professor in the Department of Community Health Sciences at the university's Fielding School of Public Health. "We have spent a lot of time looking at health disparities over the last 20 years and yet rural and urban disparities haven't been front and center."
People who live in rural areas have a lot of the same challenges as inner city people, Wallace said. "These include safety, getting enough physical activity and even getting good nutrition—in spite of all the food growing around many of them—the more rural the location, the more difficult it often is. Additionally, young adults have migrated from rural farming areas, leaving people with the lowest incomes and the least opportunity—both factors correlate strongly with life expectancy."
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