A recent report by the US Department of Agriculture found that working-age rural residents die of natural causes at a higher rate than their urban counterparts. And this gap has widened over the years.
The new report from the US Department of Agriculture finds that rural working-age adults are dying of natural causes at a faster rate than their urban counterparts, and that gap has widened dramatically over the past two decades.
Rural adults ages 25 to 54 died of natural causes at a 6 percent higher rate than urban residents in 1999. Twenty years later, that number grew to 43 percent, the report found.
These death rates, based on data from the Centers for Disease Control, declined over the two-decade period for urban adults in the age group.
The more rural the area, the greater the increase in working-age natural death rates (or the smaller the decrease) over time, according to the report.
The study did not conclude what is behind the increased death rate for rural adults, but its authors said shortages of hospitals and doctors are likely a factor. Differences in state rollout of the Medicaid expansion could also influence how often people seek care, the study found.
Alan Morgan, chief executive of the National Rural Health Association, said the report was disconcerting but not surprising. He said in many rural areas there is a lack of access to care, making it difficult to detect medical conditions early, especially cancer.
It’s just a matter of not having access to local care and also taking time off to be able to drive an hour or two to seek care, Morgan said. It doesn’t seem like a big barrier at first glance, but it is.
Morgan said rural hospital closings are affecting life expectancy.
Since the beginning of 2005, about 190 rural hospitals have closed or converted to no longer offer hospital services, according to the Cecil G. Sheps Center for Health Services Research at the University of North Carolina.
That number is likely to grow, according to Harold Miller, president and CEO of the Center for Healthcare Quality and Payment Reform.
We have estimated that more than 600 hospitals across the country are at risk of closing over the next few years because of the financial problems they are facing, Miller said.
He said a few billion dollars will bring rural hospitals out of the deficit.
We spend $100 trillion on health care nationally, so it would be less than a tenth of a 1 percent increase in health care spending to be able to keep these essential services open, he said. So I think it’s a very important thing for people to recognize.”
Rural mortality rates driven by women
Although the rate among working-age rural residents grew overall, different populations experienced varying levels of increase. For example, Indigenous men and women experienced the largest rate increases, with Indigenous women seeing the largest rate increase over the 20-year period, at 55%.
Overall, the rate grew faster for women, the report said.
Mary Gowin, a professor at the University of Oklahoma Health Sciences Center and director of the schools’ Division of Primary Care Health Policy, said the rate of increase among women is concerning.
While cancer and heart disease were the leading causes of natural death among men and women, pregnancy-related deaths grew by 313%.
Gowin points to the rise of maternity care deserts in Oklahoma and other Great Plains states, meaning women must travel farther to seek obstetric care.
So I think that’s really important to me in my work and it’s also a big issue in a lot of the states that have these high rates of pregnancy-related deaths, Gowin said.
He said struggling rural hospitals, social determinants of health and political impacts all play a role in the disparity.
Morgan of the National Rural Health Association agrees that there is no single answer to how to improve access to care in rural populations or outcomes.
I think it’s easy to look at this report and realize how horrible the situation is. That said, it drives innovation, Morgan said. And I think that, at the end of the day, this report just makes it clear that our current health care system is not working properly, or how we would all like it to work.
This story was produced in collaboration with Harvest Public Media, a collaboration of Midwestern public media newsrooms. It reports on food systems, agriculture and rural issues.
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