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Rural Americans experience significant health disparities, including higher incidence of disease and disability, increased mortality rates, and lower life expectancies as compared to the general population. Heart disease is the leading cause of death in the United States for both men and women. 1 However, when comparing rural–urban disparities in heart disease, Knudson, Meit, and Popat found:

  • For adults 20 years and older, patterns of ischemic heart disease (IHD) death rates for men and women were highest in the nation's most rural counties.

  • For both men and women, residents of the most rural counties had the highest age-adjusted prevalence of obesity.

  • Nationwide, physical inactivity during leisure time was most common for men and women in rural counties when compared to urban counties. 2

Life expectancy at birth is one of the most frequently used indicators of health status. Singh and Siahpush examined trends in rural–urban disparities for all-cause and cause-specific mortality in the United States between 1969 and 2009. 3 Key findings included:

  • Mortality risks for both males and females and for blacks and whites have been increasingly higher in nonmetropolitan than metropolitan areas, particularly since 1990.

  • Disparities widened over time; excess mortality from all causes combined and from several major causes of death in nonmetropolitan areas was greater in 2005–2009 than in 1990–1992.

  • Causes of death contributing most to the increasing rural–urban disparity and higher rural mortality include heart disease, unintentional injuries, chronic obstructive pulmonary disease (COPD), lung cancer, stroke, suicide, diabetes, nephritis, pneumonia/influenza, cirrhosis, and Alzheimer disease. 3 In fact, one-third of all motor vehicle accidents occur in rural areas, but two-thirds of motor vehicle deaths occur on rural roads. Rural residents are also nearly twice as likely as urban residents to die from unintentional injuries other than motor vehicle accidents. 4


According to the Federal Office of Rural Health Policy definition of rural, approximately 61 million people (about 20% of the population in the United States) live and work in rural areas. Where a person lives can determine their health status, health risks, and health outcomes. The interplay between six key factors that make up “place” is referred to as the social determinants of health. These include:

  • Economic stability

  • Education

  • Food

  • Neighborhood and physical/built environment

  • Social and community context

  • Health care

Rural Americans face significant challenges in all six factors.

Economic Stability

The economy in rural areas has suffered significantly from the decline in both agricultural and manufacturing jobs. Although rural employment growth increased a percentage point in 2014 after stagnating for 2 years, the number remains below what it was in 2007. 5 According to the U.S. Department of Agriculture (USDA) Economic Research Service:

  • The rural poverty rate in 2014 was an estimated 18.1%, whereas the urban rate was 15.1%.

  • Poverty rates for rural children underwent the largest increase during the ...

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