Research Article
Widening Rural–Urban Disparities in Life Expectancy, U.S., 1969–2009

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Background

There is limited research on rural–urban disparities in U.S. life expectancy.

Purpose

This study examined trends in rural–urban disparities in life expectancy at birth in the U.S. between 1969 and 2009.

Methods

The 1969–2009 U.S. county-level mortality data linked to a rural–urban continuum measure were analyzed. Life expectancies were calculated by age, gender, and race for 3-year time periods between 1969 and 2004 and for 2005–2009 using standard life-table methodology. Differences in life expectancy were decomposed by age and cause of death.

Results

Life expectancy was inversely related to levels of rurality. In 2005–2009, those in large metropolitan areas had a life expectancy of 79.1 years, compared with 76.9 years in small urban towns and 76.7 years in rural areas. When stratified by gender, race, and income, life expectancy ranged from 67.7 years among poor black men in nonmetropolitan areas to 89.6 among poor Asian/Pacific Islander women in metropolitan areas. Rural–urban disparities widened over time. In 1969–1971, life expectancy was 0.4 years longer in metropolitan than in nonmetropolitan areas (70.9 vs 70.5 years). By 2005–2009, the life expectancy difference had increased to 2.0 years (78.8 vs 76.8 years). The rural poor and rural blacks currently experience survival probabilities that urban rich and urban whites enjoyed 4 decades earlier. Causes of death contributing most to the increasing rural–urban disparity and lower life expectancy in rural areas include heart disease, unintentional injuries, COPD, lung cancer, stroke, suicide, and diabetes.

Conclusions

Between 1969 and 2009, residents in metropolitan areas experienced larger gains in life expectancy than those in nonmetropolitan areas, contributing to the widening gap.

Introduction

Life expectancy is an important health indicator and a key measure of human development globally.1, 2, 3, 4 Since 1990, reducing health inequalities and increasing life expectancy have been the two most important overarching goals for the U.S., as specified in its national health initiative, Healthy People.1, 2, 3

Life expectancy estimates are routinely available for gender and broad racial/ethnic groups in the U.S.5, 6, 7, 8 Many U.S. studies have analyzed spatial–temporal patterns in mortality,9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21 and a few studies have reported differentials in life expectancy according to SES or area-based deprivation level.22, 23, 24 Estimates of U.S. life expectancy according to urbanization level are limited, particularly analysis of trends in life expectancy among rural and urban populations over time.25 Although substantial disparities in life expectancy exist among gender, racial/ethnic, and socioeconomic groups in the U.S., it is important to know the magnitude and causes of life expectancy disparities been rural and urban areas for the purposes of social planning and public health decision making.

Life expectancy is a summary index of mortality that can be used to document both absolute and relative inequalities in survival between rural and urban populations.22 It manifests the effects of excess mortality risks during infancy, childhood, youth, working ages, and old age as well as those from major chronic and communicable diseases. The aim of this study is to examine changes in the extent of rural–urban inequalities in U.S. life expectancy between 1969 and 2009. A county-based rural–urban variable was linked to national mortality data to examine the extent to which differences in life expectancy among U.S. men and women in metropolitan and nonmetropolitan areas have changed during the past 4 decades. For the most recent time period, life expectancies at birth were derived for metropolitan and nonmetropolitan areas stratified by race, gender, and income. Rural–urban disparities were decomposed in life expectancy attributable to excess mortality in specific age groups and causes of death.

Section snippets

Methods

The 1969–2009 national vital statistics mortality database was used to analyze temporal rural–urban inequalities in U.S. life expectancy.5, 6, 7, 8, 22, 26 Because the national mortality database does not allow direct computation of life expectancies for people in rural and urban areas, the 1974, 1983, 1993, and 2003 rural–urban continuum variables were linked to the age-, gender-, race-, and county-specific mortality statistics from 1969–1980, 1981–1989, 1990–1998, and 1999–2009, respectively,

Results

Table 1 presents selected sociodemographic and health characteristics by urbanization level. SES is generally inversely related to levels of rurality, with higher poverty and lower education and income levels found in nonmetropolitan than metropolitan areas. Metropolitan and urban areas had a higher proportion of minority and immigrant populations, whereas nonmetropolitan and rural areas were more likely to be medically underserved. Rural and nonmetropolitan areas were also more likely to be

Discussion

Life expectancy in the U.S. has increased consistently during the past 4 decades, albeit at a modest pace, rising from 70.8 years in 1970 to 78.7 years in 2010.5, 6, 7, 8 In contrast to the consistent improvements in overall life expectancy, this study reveals substantial and increasing urban–rural disparities in U.S. life expectancy over time, with the gap widening from 0.4 years in 1969–1971 to 2.0 years in 2005–2009. Racial disparities in life expectancy were very marked in both metropolitan

Acknowledgments

The views expressed are the authors’ and not necessarily those of the Health Resources and Services Administration or the USDHHS.

No financial disclosures were reported by the authors of this paper.

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