Over the past few decades, the number of deaths among rural Americans has surpassed the number of deaths for those who live in metropolitan areas, according to Mississippi State University researchers.
For about a century, those who lived in what are classified as rural areas lived longer than city dwellers, but that trend began to reverse in the mid-1980s.
Researchers analyzed mortality data covering the years 1968 to 2005 obtained from the National Center for Health Statistics. The findings were published June 17 in the American Journal of Public Health.
Here are some reasons why city versus rural mortality trends appear to have reversed:
Access to care in rural areas
"Grant County is rural, and we are also a health care provider shortage area," said Jeff Kindrai, administrator of the Grant County (Wis.) Health Department.
Relatively limited access to health care providers could prohibit some people from enjoying the benefits of preventive care and could make it more difficult for them to see a specialist in a timely manner.
"There are fewer doctors in rural areas, and most of the doctors in rural areas are not specialists; they are general practitioners," said Peg Murphy, administrator of the Jo Daviess County (Ill.) Health Department.
Limited access to a specialist could result in a lag in receiving treatment for diseases such as cancer.
Changes in rural health behaviors
"You have to look at lifestyle," said Jackson County (Iowa) Public Health Department Administrator Frank Frieberg. "Traditionally, there was a lot of strenuous activity associated with people living in rural areas. These days, many rural residents are merely city dwellers who have moved to the countryside."
People in rural areas traditionally had easy access to healthy food.
"Now, in Grant County, we are working on increasing levels of physical activity and consumption of fruits and vegetables," Kindrai said.
The University of Wisconsin recently ranked Grant County 71st out of 72 Wisconsin counties in fruit and vegetable intake.
Rates of people without insurance coverage
A study from the Urban Institute found that 22 percent of people younger than 65 in rural areas were uninsured, compared to 14 percent of urban residents.
In addition, average incomes generally are lower in rural areas than in urban ones, depressing insurance coverage.
Rates of disease occurrences in rural areas
Researchers noted that heart disease, cancer and stroke are the top three causes of death in rural areas. Rural living could pose a logistical challenge in treating these conditions.
"If you had a heart attack (in a rural area), you could have a 15-minute ambulance wait compared to a five-minute ambulance wait (in the city)," Frieberg said.