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Rural Health Disparities

Rural Americans are a population group that experiences significant health disparities. Health disparities are differences in health status when compared to the general population, often characterized by indicators such as higher incidence of disease and disability, increased mortality rates, lower life expectancies, and higher rates of pain and suffering.

Rural risk factors for health disparities include geographic isolation, lower socio-economic status, higher rates of health risk behaviors, and limited job opportunities. Higher rates of chronic illness and poor overall health are found in rural communities when compared to urban populations.

Several studies have shown that rural residents are older, poorer, and have fewer physicians to care for them. This inequality is intensified as rural residents are less likely to have employer-provided healthcare coverage, and if they are poor, often are not covered by Medicaid. Federal and state agencies and membership organizations are working to diminish these disparities and keep rural America healthy and strong. Some provide funding, information, and technical assistance to be used at the state, regional, and local level, while others inform state and federal legislators to help them understand the issues affecting healthcare in rural America.

Frequently Asked Questions


How do rural mortality rates compare to urban?

 

Rural Mortality Rates Compared to Urban Rates per 100,000 Population
  Nonmetro counties Metro counties
Measure With a city ≥ 10,000 population Without a city ≥ 10,000 population Large central Large fringe Small
Infant mortality 6.8 7.0 6.8 5.7 6.7
Chronic obstructive pulmonary disease (COPD), death rate among persons 20 years of age or older 79.9 81.9 56.2 60.6 70.9
Death rates for ischemic heart disease among persons 20 years of age and older 197.2 206.5 192.9 174.9 173.8
Death rates for all unintentional injuries 58.9 52.7 32.1 33.1 40.8
Death rates for all motor vehicle traffic-related injuries 23.3 19.5 7.9 9.3 12.1
Suicide 18.2 20.0 12.8 13.7 16.1

Source: Rural Health Reform Policy Research Center. The 2014 Update of the Rural-Urban Chartbook. (2008–2011 data.)


How does rural life expectancy compare to urban?

 

Rural Life Expectancy Compared to Urban, 2005-2009, in Years of Age
  Nonmetro counties Metro counties
Life Expectancy, All

76.8

78.8

Life Expectancy, Male

74.1

76.2

Life Expectancy, Female

79.7

81.3

Life Expectancy, White

77.2

79.2

Life Expectancy, Black

72.8

74.2

Life Expectancy, American Indian and Alaska Native

74.8

85.8

Life Expectancy, Asian and Pacific Islander

84.9

86.9

Life Expectancy, Hispanic

82.2

83.1

Source: Singh, G.K., Siahpush, M. 2014. Widening Rural-Urban Disparities in Life Expectancy, U.S., 1969-2009. American Journal of Preventive Medicine, 46(2), 19-29. Article Abstract


How does rural health status compare to urban?

 

Rural Health Status Compared to Urban Rates
  Nonmetro counties Metro counties
Low birth weight*

8.3 %

8.2 %

Teen birth rate*

49.5 %

39.2 %

Children who are overweight†

25.0 %

19.0 %

Preventable hospital stays*

84.0 %

69.3 %

Diabetes incidence*

10.6 %

9.9 %

Percent of population receiving appropriate screening and diagnosis of Type 2 diabetes*

83.1 %

84.5 %

Measure With a city ≥ 10,000 population Without a city ≥ 10,000 population Large central Large fringe Small
Limitation of activity caused by chronic health conditions among persons 18 years of age and older

17.1%

18.8%

12.9%

11.9%

14.7%

Edentulism (total tooth loss) among persons 65 years of age and older

28.8%

33.3%

22.7%

19.2%

23.9%

Sources: Rural Health Reform Policy Research Center. The 2014 Update of the Rural-Urban Chartbook. (2008–2011 data.)
*South Carolina Rural Health Research Center data analysis using 2013 Robert Wood Johnson County Rankings dataset and the HRSA Area Health Resource File 2012-2013
†Joens-Matre, R.R. , Welk, G.J., Calabro, M.A., Russell, D.W., Nicklay, E., Hensley, L.D. 2008. Rural-Urban Differences in Physical Activity, Physical Fitness, and Overweight Prevalence of Children. Journal of Rural Health, 24(1), 49-54. Article Abstract


What is the difference between health disparities and health inequities?

Heathy People 2020 defines health disparities as:

"a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion."

Health equity is defined by the National Partnership for Action to End Health Disparities as the:

"attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities."

To achieve health equity, we must eliminate all disparities in healthcare and the associated factors that influence health.

Lastly, health inequity is defined in CDC’s Social Determinants of Health Definitions as the:

"difference or disparity in health outcomes that is systematic, avoidable, and unjust."

What are the causes of rural health disparities?

Causes of health disparities in rural America include healthcare access, socioeconomic status, unhealthy behaviors, and chronic conditions.

Access to Healthcare

Rural people experience many barriers to healthcare access which can contribute to health disparities. The following factors create access difficulties for rural Americans:

  • The uninsured rate is higher in the rural counties (nonmetropolitan) than in the urban (metropolitan) counties as reported by CDC’s National Center for Health Statistics.
  • Healthcare workforce shortages are prevalent with less than 10% of all physicians choosing to practice in rural settings.
  • Services available in rural areas are less likely to include specialized and highly sophisticated or high-intensity care. This exacerbates the problems with distance to care for people requiring higher levels of care. For some services, such as Emergency Medical Services, the lower level of care available, when added to the increased time to services caused by distance, can be the difference in life or death.
  • According to a 2005 USDA Information Bulletin, Rural Transportation at a Glance, rural residents are more dependent on public transportation. However, transportation options are fewer, as only 60% of rural counties have public transportation available

Socioeconomic Status

According to Kaiser Commission on Key Facts, The Uninsured in Rural America, Medicaid insures a significant portion of the rural population because of the high rates of poverty in rural areas and lower rates of insurance coverage. Rural residents are more likely to be unemployed, have lower rates of post-secondary education, and have lower median household incomes than urban residents; and according to a 2005 Health Affairs article, those who have health insurance pay a greater percentage of their income in out-of-pocket healthcare costs. Research has shown that these and other social determinants of health have a significant effect on health status.

Health Behaviors

According to an analysis conducted by the South Carolina Rural Health Research Center of 2013 County Health Rankings dataset and the 2012-2013 HRSA Area Health Resource File, rural adults are more likely than their urban counterparts to:

  • Smoke
  • Abuse alcohol and other substances
  • Be physically inactive
  • Be overweight
  • Have poor access to healthy foods

These poor health behaviors contribute to health disparities, such as disease incidence and lower life expectancies.


Where can I find supporting documents and statistics on rural health disparities?

Several publications identify and describe the rural/urban disparities.

The 2014 Update of the Rural-Urban Chartbook
Highlights current trends and disparities across different levels of metro- and nonmetropolitan counties. Includes population characteristics, health-related behaviors and risk factors, mortality rates, and healthcare access and use. Individual data tables are available in an Excel file.

National Healthcare Disparities Report
Produced annually by the Agency for Healthcare Research and Quality (AHRQ), provides a comprehensive national overview of disparities in healthcare among racial, ethnic, and socioeconomic groups in the general U.S. population and rural areas. Tracks the success of activities to reduce disparities. (2013)

Bridging the Health Divide: The Rural Public Health Research Agenda
Prepared by the University of Pittsburgh Center for Rural Health Practice presents background information, facts and insights into rural health disparities. (2004)

Health Disparities: A Rural-Urban Chartbook
Presents data on health disparities experienced by people living in rural America. Some disparities identified are poorer health status, higher prevalence of obesity, lesser options for activity and higher mortality rates. (2008)

Health, United States, 2013: With Special Feature on Prescription Drugs
Presents an annual overview of national trends in health statistics. Covers health status and determinants, healthcare utilization, access and expenditures. Includes data on rural areas - see index under "Metropolitan/nonmetropolitan data." This year's edition includes a section on prescription drugs. (2014)

Rural Healthy People 2020
Texas A&M’s Health Science Center School of Rural Public Health’s Southwest Rural Health Research Center published Rural Healthy People 2020 to provide a resource that documents the successes, challenges, and relevant information for planning.

Rural Health Research Gateway: Health Disparities Topic
Provides publications and projects on the topic of rural health disparities developed by rural health research centers that are funded by the federal Office of Rural Health Policy (ORHP).

For additional information on rural/urban disparities see RAC’s FAQ, What sources cover health behaviors and health status for rural areas or by county?


What agencies and organizations are working to seek solutions to these disparities?

  • Office of Rural Health Policy (ORHP)
    ORHP, part of the Health Resources and Services Administration under the U.S. Department of Health and Human Services, promotes better healthcare service in rural America. ORHP focuses on matters affecting rural hospitals and healthcare, coordinating activities within the department that relate to rural healthcare, maintaining a national information clearinghouse, and providing rural-specific grant programs to address many of the disparities affecting rural health. Several Rural Health Research Centers are funded by the ORHP to help policy makers understand the problems rural communities face in regards to health disparities and in assuring access to healthcare. Their research findings inform a wide audience of national, state, and local decision-makers concerned with rural health.
  • Agency for Healthcare Research and Quality (AHRQ)
    Sponsors and conducts research with a segment focused on rural health that provides evidence-based information on healthcare outcomes; quality; and cost, use, and access. AHRQ publishes an annual National Healthcare Disparities Report that summarizes healthcare quality and access in the United States among priority populations including people with disabilities, rural populations and racial, ethnic, and socioeconomic groups.
  • National Institute on Minority Health and Health Disparities
    Leads scientific research to improve minority health and eliminate health disparities through research, training of a diverse workforce, research capacity and infrastructure development, public education and information dissemination programs.
  • National Rural Health Association (NRHA)
    Promotes leadership, ideas, information, communication, education, research, advocacy, and methods to improve rural health and reduce health disparities. The organization is composed of individual and organizational members who share a common interest in rural health.

For additional information on rural health research see the Conducting Rural Health Research, Assessments and Evaluation topic guide.


What are the health disparities that affect rural minority populations?

Rural minority populations often experience health disparities related to their health status, rates of chronic disease, life expectancy, and rates of unintentional injury. Health Disparities: A Rural – Urban Chartbook shows health disparities for rural minority populations as compared to other racial or ethnic groups, including:

  • Rural blacks, Hispanics, and American Indians were more likely to report fair or poor health
  • Rates of diabetes were higher among rural American Indian and black adults
  • Rural black adults were at higher risk for obesity than their urban counterparts
  • American Indians in small rural counties adjacent to metropolitan areas were more likely to report limitations in their activities due to physical, mental and emotional problems

In the article All-Cause and Cause-Specific Mortality Among US Youth: Socioeconomic and Rural-Urban Disparities and International Patterns, the authors found that rural American Indian and Alaska Native (AI/AN) youth have a higher mortality rate than their urban counterparts. Additionally, the rate of substance abuse admissions was higher for rural AI/AN than for those residing in urban areas according to a SAMHSA report.

Rural minorities face a myriad of issues that can affect their health ranging from chronic poverty, to a lack of stable medical care for migrant workers, and to language barriers experienced by newcomers to this country. According to the HHS Action Plan to Reduce Racial and Ethnic Health Disparities the two major factors contributing to their disproportionate health problems are inadequate access to care and substandard quality of care. Several federal government agencies within the Department of Health & Human Services work to eliminate the health disparities experienced by minority populations:

  • HHS Office of Minority Health
    Dedicated to improving the health status of racial and ethnic minorities, eliminating health disparities, and achieving health equity in the United States
  • National Partnership for Action (NPA)
    Works to mobilize and connect individuals and organizations across the country to create a nation free of health disparities, with quality health outcomes for all people
  • Office of Rural Health Policy (ORHP)
    Has had a longstanding concern with the diverse health needs of rural minority populations and provides information, expertise and grant opportunities to address the inequities found in rural minority health populations
  • CDC's Office of Minority Health & Health Equity (OMHHE)
    Aims to accelerate CDC’s health impact in the U.S population and to eliminate health disparities for vulnerable populations as defined by race/ethnicity, socio-economic status, geography, gender, age, disability status, risk status related to sex and gender, and among other populations identified to be at-risk for health disparities.

Also, each state has a state office of minority health or health equity office designated to reduce health disparities within their state that provides state-level health information and resources targeted toward minority populations.