Gap in rural and urban death rates tripled from 2009 to 2019

Mortality trends by area type (graph from JAMA study)

"The gap between the death rates of rural and urban U.S. residents tripled over the past two decades as city-dwellers enjoyed robust health improvement and drugs and disease pervaded the countryside," Carey Goldberg reports for Bloomberg. "Death rates dropped in all groups except middle-aged rural white and Native American people, but fell most in cities."

That's according to a study published in the Journal of the American Medical Association that examined age-adjusted all-cause mortality in the U.S. from 2009 to 2019. Though overall mortality rates dropped in rural, suburban and urban areas, suburban and urban death rates fell much further. The researchers classified rurality according to the U.S. Census Bureau definition. 

"The numbers add to disturbing findings in recent years that life expectancy has actually dropped among some Americans, particularly white people with less education, fueled largely by 'deaths of despair' from substance use or suicide," Goldberg reports. 

The trend is "a ripple effect from the economic downturn in rural areas that’s now being manifested as a public health crisis," senior author and Boston heart specialist Haider Warraich told Goldberg. The data, combined with other studies, show chronic diseases, substance use, poor nutrition, lack of exercise, rural hospital closures, and lack of access to quality medical care all contribute to the phenomenon.