Are There Place-Based Disparities in Mortality Risk? Findings from Two Longitudinal Studies of Aging

Abstract

Objective: Most work on rural-urban health disparities has been conducted with population-level data, which is limited in its capacity for causal inferences about individuals and lifespan health. The present study leverages individual-level longitudinal data, spanning up to 29 years, to understand how rurality-urbanicity predicts risk for all-cause mortality; whether these associations hold above and beyond socioeconomic status; and whether the association between rurality-urbanicity and mortality risk varies by sex, socioeconomic status, race, ethnicity, and partner status.Methods: The present pre-registered study uses data from two large longitudinal studies of U.S. Americans (HRS and MIDUS; total N = ~55,000), who reported on their socio-demographic characteristics, had their addresses linked to geographical indicators (i.e., rural-urban continuum codes), and have data from the National Death Index regarding vital status and survival time. Results: Using cox proportional hazards regression models, findings showed that suburban and rural residents were at a 12% and 18% greater risk for earlier mortality compared to urban residents in HRS, but the associations between rurality-urbanicity and mortality risk were non-significant in MIDUS. The longitudinal associations between rurality-urbanicity and mortality risk were largely independent of socioeconomic status. Finally, there was only one statistically significant interaction effect, suggesting the strength and direction of the association between rurality-urbanicity and mortality risk was largely the same across sociodemographic subgroups. Conclusions: There is tentative evidence suggesting that rurality-urbanicity is an important social determinant of longevity, over and above other sociodemographic factors. Future studies should explore how to promote longer and healthier lives among rural residents.