SdoH: Mortality Disparities Between Urban and Rural Residents

Original story posted on: February 19, 2020

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The divide between the two populations has consistently widened.

Rural communities face an increasing number of challenges that impact their health and wellness. A new study has identified those that are most significant, and while the industry is abuzz, there were few surprises to those of us who have been following the social determinants of health (SDoH).

The study was conducted by researchers from the F. Marie Hall Institute for Rural and Community Health at the Texas Tech University Health Sciences Center. Their goal was to determine why such a large disparity exists in the U.S. between the mortality rate for rural residents and that of urban dwellers. The divide between these two populations has consistently widened since the 1980s, with the root causes an area of focus.

The study focused on five explanatory variables within each area reviewed:

  • Socioeconomic deprivation (e.g., poverty status, access to housing and education, employment)
  • Uninsured rates
  • Supply of and access to primary care physicians
  • Percentage of racial or ethnic groups
  • Number of rural and urban residents

If you think these variables sound familiar, it’s no coincidence. Each has been addressed in the context of rural health’s challenges with the SDoH. These regions face gross difficulties, courtesy of economic hardship and high numbers of unemployed and uninsured, not to mention the vast provider deserts that have emerged courtesy of hospital closures, retiring primary care and specialty physicians, and recruitment challenges. Medicare beneficiaries with chronic illnesses, such as heart failure or diabetes, who live in these regions, have far higher death and hospitalization rates than those living in urban and suburban settings. Why? Abundant data has validated that lack of access to specialists remains the primary reason.

In addition, rural populations also face a serious lack of behavioral health providers and programs, with the term “barren wasteland” having unfortunate new meaning for these areas.

The research results yielded three of the explanatory variables applicable, each significantly associated with mortality: socioeconomic deprivation, percentage of uninsured, and the primary care physician supply. The domains accounted for an astounding almost 82 percent of the total variance. When comparing the numbers across the states, Colorado, Montana, and Wyoming were the only states that were exceptions.

The impact of further closure of rural hospitals continues to be a major factor for the industry to reconcile. More than 110 have closed over the past decade, with more than 430 facilities still at risk. Rural communities have hit a tipping point that must be addressed if residents are to receive quality health and behavioral care.

Programming Note: Listen to Ellen Fink-Samnick’s live reporting on the State of the Social Determinants weekly on Monitor Mondays, 10-10:30 a.m. EST.

Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CRP

Ellen Fink-Samnick is an award-winning healthcare industry expert. She is the esteemed author of books, articles, white papers, and knowledge products. A subject matter expert on the Social Determinants of Health, her latest books, The Essential Guide to Interprofessional Ethics for Healthcare Case Management,  Social Determinants of Health: Case Management’s Next Frontier (with Foreword by Dr. Ronald Hirsch), and End of Life Care for Case Management are published through HCPro. She is a panelist on Monitor Mondays, frequent contributor to Talk-Ten-Tuesdays, and member of the Editorial Advisory Boards of Professional Case Management, Case Management Monthly, and RAC Monitor. Ellen also serves as the Lead for Rise Association’s Social Determinants of Health Community.

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