Health Affairs Lower Incomes , Education , And Health Coverage Higher Risk Of Death In Rural Blacks And Whites Than Urbanites Is Related To

Health outcomes among rural minority populations are seldom examined. Our research studied mortality among urban and rural white, black, and Hispanic adults ages 45–64, comparing outcomes for each group. We found the mortality risk to be higher among both rural white and rural minority populations compared to urban whites; rural blacks were at higher risk of death than urban blacks. When personal characteristics and circumstances of these populations—such as level of education, presence of health insurance, and income above or below the poverty line—were held statistically equal, disparities were reduced or eliminated. Our study suggests that policies directed toward reducing differences related to education, poverty, and health insurance would go a long way toward eliminating the disparities in health status between urban and rural populations. M inority rural adults live at the intersection of two sources of disadvantage that might translate into poorer mortality outcomes: race or ethnicity and residence. Race-based mortality disparities have been documented among nonHispanic black adults and American Indian and Alaska Native populations, although Hispanic adults generally do not differ from whites. Excess mortality—generally death that occurs before a person reaches average life expectancy—has also been found among residents of nonmetropolitan US counties, although some rural communities differ from this trend. Our research examined mortality among people in middle age to see whether these two potential sources of disparity combine to adversely affect rural, minority populations. We chose adults of preretirement age because prior research suggests that mortality disparities associated with race and ethnicity are particularly acute for people ages 45–64. Specifically, we estimated total and relative mortality among black and Hispanic adults, by residence, and investigated factors that contribute to mortality. Study Data And Methods Data Source And Population We used information from the 2010 National Health Interview Survey Linked Mortality File, developed by the National Center for Health Statistics. This nationally representative data set links respondent information from the 1986–2000 survey interviews to National Death Index files through December 31, 2006, using a probabilistic matching algorithm. Our analysis was restricted to white, nonHispanic black (hereafter, black) and Hispanic people who were ages 45–64 at the time of the survey interview. We did not study adults in the Asian/Pacific Islander or American Indian/ AlaskaNative categories because of small sample sizes.We further restricted our sample to people with complete data on the principal variables of interest, including whether they were alive or doi: 10.1377/hlthaff.2011.0668