New study helps explain why rural Americans die younger: chronic ills, food deserts, health-care access, outmigration

Starting in the 1990s, life expectancy in rural areas fell below that in urban areas, and "The gap keeps growing . . . mainly among prime working-age adults (ages 25–54), which has important implications for rural health, productivity, and economic development," says a new study from the University of Illinois and the Agriculture Department, which tries to explain why. 

It "points to the structural, economic, and retail environments of the counties they live in," writes C.J. Miller of Hoosier Ag Today. The increasing rural death rate is increasingly driven by chronic illnesses such as "heart disease and diabetes, rather than external crises like suicides or drug overdoses. Crucially, the study found that these health disparities largely vanish when accounting for specific county-level characteristics, suggesting that the 'place' itself dictates survival. . . . when the researchers ran linear regression models that adjusted for the local environment—including the density of grocery stores, recreational facilities, local labor force participation, and per-capita income—the statistical significance of a person’s “rural” status virtually disappeared."

Past studies have usually pointed to personal choices; this one looks at the assets (or lack of them) in rural counties that contribute to health and wellness, as Miller describes:

• Food and retail deserts: Rural counties often feature a higher concentration of fast-food establishments relative to full-service grocery stores, making nutritional compliance a geographic challenge.
• Health care access: Decades of rural hospital closures and a persistent shortage of physicians mean chronic conditions like cardiovascular disease are frequently caught later and managed poorly.
• Socioeconomic stress: Lower personal income and suppressed labor force participation rates contribute to an elevated “allostatic load”—the medical term for the cumulative biological wear-and-tear caused by chronic stress.
• Digital divide: Modern health literacy increasingly relies on a robust information environment. A lack of high-speed broadband internet in rural areas limits access to telehealth services and health education.

"The study also touched on the complicated role of internal migration, noting that urban centers frequently attract healthier, upwardly mobile individuals from rural communities — a phenomenon known as the 'healthy migrant hypothesis,' leaving behind a rural population that is older, poorer, and less biologically equipped to withstand structural neglect," Miller reports.

The study was done by researchers at UI Urbana-Champaign and the USDA's Economic Research Service and published in the peer-reviewed journal Economics & Human Biology. It used "restricted-use files from the National Health and Nutrition Examination Survey spanning 1999 to March 2020. This allowed them to link individual health metrics, including objective laboratory indicators like blood-drawn cholesterol levels and glycohemoglobin (blood sugar tracking), with the specific federal county codes of the participants," Miller reports.