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Member Research and Reports

Member Research and Reports

East Tennessee Publishes on Rural Community Vulnerability

Drs. Nathan Hale, Kate Beatty, and Michael Smith, professors in the Department of Health Services Management and Policy in the East Tennessee State University College of Public Health, and members of the Center for Rural and Appalachian Health, recently published research on mortality rates in rural communities in The Journal of Rural Health.  The article, “The Intersection of Residence, Community Vulnerability, and Premature Mortality,” examines rural-urban differences in mortality-related outcomes within comparable levels of deprivation.

Premature mortality is an important measure of population health that is often used to measure mortality-related outcomes and health disparities.  Over the past four decades, life expectancy in the United States had increased steadily.  Recent data, however, suggest that life expectancy has actually declined in each of the previous two years.

Previous research has noted that rural populations often experience higher rates of mortality than their urban counterparts with gaps widening in over time. Expanding on previous research, this study provides a more nuanced analysis of rural-urban differences in premature mortality. While many rural communities face significant social and economic barriers that can have an effect on overall health and well being, not all rural communities face these challenges. Examining rural–urban differences alone may not provide a complete picture of rural and urban health disparities.

To address this issue, the researchers conducted a cross-sectional with data derived from the 2017 County Health Rankings, which included 3,141 U.S counties. Multiple indicators reflecting key social and economic vulnerabilities within a community were combined into a single measure of vulnerability. After grouping counties based on the underlying level of vulnerability, the team then examined rural-urban differences in premature mortality within comparable groups. Additional county-level measures of health behaviors, self-reported health status, and health delivery system capacity were also included in the analysis.

The research team noted a differential effect in mortality-related outcomes among rural counties within comparable levels of community deprivation. The rate of premature mortality increased in all counties with increasing levels of community vulnerability. However, as the level of community vulnerability increased, the trajectory of the increase in premature mortality was much higher in rural communities compare to their urban counterparts.

This suggests that residing in rural communities that are also socially and economically vulnerable may have a compounding effect—a double disadvantage. This underscores the need for a continued focus on the development and implementation of multiple policies aimed at reducing differences in poverty, education, and access to care.