Since the 1980s, the all-cause mortality rate in the U.S for rural residents has exceeded that of urban dwellers. In a recently completed study, researchers from the F. Marie Hall Institute for Rural and Community Health at the Texas Tech University Health Sciences Center (TTUHSC) sought to determine why this disparity exists in general, and why specifically this imbalance varies so much between states.
The results from their study, "Higher U.S. Rural Mortality Rates Linked To Socioeconomic Status, Physician Shortages, And Lack Of Health Insurance," were published in the December issue of Health Affairs Journal.
Gordon Gong, M.D., Ph.D., an associate professor of rural and community health who recently retired from TTUHSC, authored the study. Scott Phillips, editor in chief for TTUHSC's Rural Health Quarterly magazine and a co-author to the study presented the results Dec. 4 at the Health Affairs Rural Health Forum hosted by the National Press Club in Washington D.C.
Phillips said the study spun off of a U.S. rural health report card that he, Gong and others have been putting together since 2016. They started the report card by trying to answer one question: how well does Texas stack up to other states when it comes to providing quality rural health care?
"We couldn't really answer that question, and we found that no one else had really tried," Phillips said. "We created this data set of every rural and urban county in the U.S. so we could see the disparities."
Developing the report card allowed the TTUHSC team to rank states based upon their grades for outcomes and access, but it made no attempt to explain the disparities.
This latest study is the next step where we try to explain why rural areas do so much worse than urban areas when it comes to health outcomes, and why the disparities are so widely spread among the states. We noticed some patterns in the early days of working on the report card that gave us a good starting place for this study." Scott Phillips, editor in chief for TTUHSC's Rural Health Quarterly magazine
According to Phillips, the study focused on five explanatory variables within each county: socioeconomic deprivation (e.g., poverty status, access to housing and education, employment), uninsured rates, the supply of and access to primary care physicians, the percentage of racial or ethnic groups and the number of rural and urban residents.
However, after compiling all of the data, the TTUHSC researchers discovered that only three of their explanatory variables were applicable: socioeconomic deprivation, percentage of uninsured and the primary care physician supply. Phillips said those three variables accounted for 81.8% of the total variance of mortality.
"That's an impressive finding and a very large number for this kind of study," Phillips said. "The caveat is that correlation is not necessarily causation, but it's certainly a very strong hint that this is the direction where we need to marshal our resources and pay more attention."
In the end, Phillips said, the remaining variables -- the percentage of racial and ethnic groups and the number of rural or urban residents -- were not significantly associated with mortality. Related Stories
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