Decomposing Age-Adjusted Mortality Disparities in Urban and Rural US Counties (1980-2010)

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  • February 28, 2019
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  • Spencer, Jennifer
    • Affiliation: Gillings School of Global Public Health, Department of Health Policy and Management
Abstract
  • Background: Life expectancy has continued to increase across the US, however, not all groups experience these improvements equally. Evidence suggests a widening disparity in mortality is developing between rural and urban counties, but the extent to which county-level characteristics may explain this gap is unknown. Methods: County-level age-adjusted mortality was collected decennially from 1980 to 2010 and matched with county demographic, economic, and structural characteristics at each decade. Oaxaca-Blinder decomposition was used to evaluate the extent to which mortality differences by county type could be explained with changing county characteristics over this time period. Results: Differences in county characteristics were more than sufficient to explain observed mortality disparities, with counterfactual estimates predicting even higher rates of rural mortality than are observed. The primary explanatory factors were demographics, followed by economics. Results suggest an unexplained source of protection for rural counties against otherwise unfavorable characteristics, but why rural counties see better than expected outcomes is unclear. Conclusions: Rural differences in mortality rates can largely be explained through increasingly wide disparities in demographics between rural and urban counties, as well as persistent economic inequalities. As these trends show no sign of abating, mortality disparities may continue to increase. We hope that explaining the sources of these disparities will help inform policy making and drive resource allocation to address the increasing needs of the rural population.
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  • In Copyright
Advisor
  • Wheeler, Stephanie
  • Holmes, George M.
Degree
  • Master of Science in Public Health
Degree granting institution
  • University of North Carolina at Chapel Hill
Graduation year
  • 2016
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  • a462600e-de5b-4b41-a5de-60ade605b7af

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