Gendered mortality differentials over the rural-urban continuum: The analysis of census linked longitudinal data from England and Wales

Abstract

Background. Previous research shows that mortality varies significantly by residential context; however, the nature of this variation is unclear. Some studies report higher mortality levels in urban compared to rural areas, whereas others suggest elevated mortality in rural areas or a complex U-shaped relationship. Further, it also remains unclear the extent to which compositional factors explain urban-rural mortality variation, the extent to which contextual factors play a role and whether and how the patterns vary by gender. This study investigates urban-rural mortality variation in England and Wales and the causes of this variation. Method. The study applies survival analysis to the Office for National Statistics Longitudinal Study. Population aged 20 and older in 2001 are followed 10 years. Results and Conclusions. The analysis shows a clear urban-rural mortality gradient, with the risk of dying increasing with each level of urbanisation. The exceptions are those living in areas adjacent to London who consistently exhibit lower mortality than anticipated. Once the models are adjusted to individuals' socioeconomic characteristics, the variation across the urban-rural continuum reduces substantially, yet the gradient persists suggesting contextual effects. Females are found to be influenced more by their surrounding environment and males by their socioeconomic position, although both experience lower mortality in rural compared to urban areas.

Individual and contextual determinants of male suicide in the post‐communist region: The case of Lithuania

“…The urban–rural mortality divide, which began during the period of Soviet rule, has been attributed to a wide range of determinants, such as socio‐economic disadvantages, poorer access to health care, excessive alcohol consumption and psychosocial factors (Jasilionis, 2003). The persistent urban–rural mortality gradient observed in Lithuania and other former Soviet republics contrasts with the urban–rural mortality gradient observed in many Western European countries that shows a notable mortality disadvantage in urban areas (Allan, Williamson, & Kulu, 2019; Jasilionis et al, 2007). However, an increasing ‘rural mortality penalty’ (excess rural mortality) has also been reported for the United States that tends to affect poorer rural counties with less educated white populations (Cosby et al, 2019).…”

Infection rates from Covid-19 in Great Britain by geographical units: A model-based estimation from mortality data

“…Secondly, can we assume the same IFRs across geographical units? Studies show a significant variation in health and mortality in the UK across regions ( Popham, 2006 ; Allan et al, 2019 ). Hence, a 75-year old individual living in a region with relatively low life expectancy is more likely to have an underlying health condition and so to die from Covid-19 rather than a 75-year living in a region with high life expectancy (as this individual is more likely to be healthy).…”

The Short-Term Effects of European Integration on Mortality Convergence: A Case Study of European Union’s 2004 Enlargement

“…While both of these mechanisms are related to European integration, they acted in different regions at different times, and therefore did not visibly influence mortality during a narrow time window. Other national and regional characteristics—like urbanicity and rurality (Allan et al, 2019 ), net outmigration (Tunstall et al, 2016 ), and the level of unemployment (Laliotis & Stavropoulou, 2018 ) – have also been shown to be associated with population health outcomes. Their interactions with European integration require further study, preferably in the form of in-depth case studies of single regions or countries that may uncover complex and context-specific networks of cause and effect.…”