Are there place-based disparities in mortality risk? Findings from two longitudinal studies.

Abstract

Objective: Most work on place-based (e.g., 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 (SES); and whether the association between rurality-urbanicity and mortality risk varies by sex, SES, race, ethnicity, and partner status. Method: The present preregistered study uses data from two large longitudinal studies of U.S. Americans (Health and Retirement Study and Midlife in the United States; total N = 55,000), who reported on their sociodemographic characteristics, had their addresses linked to geographical indicators (i.e., rural-urban continuum codes), and have data from the National Death Index regarding the 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 Health and Retirement Study, but the associations between rurality-urbanicity and mortality risk were nonsignificant in Midlife in the United States. The longitudinal associations between rurality-urbanicity and mortality risk were largely independent of SES. 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. Public Significance StatementPeople who reside in rural, suburban, and urban areas of the United States experience different opportunities and challenges when it comes to healthcare access, proximity to amenities like fitness centers and grocery stores, and exposure to pollution, all of which impact longevity. The present research contributes to our understanding of how residing in rural, suburban, and urban areas of the United States is associated with how long people live. Findings suggest that people who reside in rural areas tend to have, on average, two fewer years of life than people who reside in urban areas, highlighting a pressing need to identify how to promote longer and healthier lives among rural residents.