Life Expectancy: Urban-Rural Disparities Widen Interview with:
Gopal K. Singh, Ph.D., M.S., M.Sc.
Senior Epidemiologist/Health Care Administrator
Office of Epidemiology and Research
Division of Epidemiology
HRSA/ Maternal and Child Health Bureau
U.S. Department of Health & Human Services
Rockville, MD 20857, USA

and Mohammad Siahpush, PhD
Professor, Department of Health Promotion, Social & Behavioral Health
University of Nebraska Medical Center
College of Public Health What are the main findings of the study?

Answer: There are significant disparities in life expectancy between rural and urban areas of the United States – and these disparities have widened over the past 4 decades. In 1969, life expectancy was 0.4 years longer in urban than in rural areas (70.9 vs. 70.5 years). In 2009, the life expectancy difference between urban and rural areas increased to 2.0 years (78.8 vs. 76.8 years). Much of the disparity appears to have increased since 1990. Life expectancy has increased more rapidly in urban than in rural areas, which has contributed to the widening gap in life expectancy.

Life expectancy is lower in more rural areas. In 2005-2009, life expectancy was 79.1 years in large metro areas, 77.8 in small metro areas, 76.9 years in small-urban towns, and 76.7 years in rural areas. So, the difference in life expectancy between the most-urban and most-rural was 2.4 years.

Mortality from cardiovascular diseases, unintentional injuries (mostly motor-vehicle accidents), lung cancer, and COPD is much higher in rural than in urban areas, and these causes collectively account for 70% of the overall rural-urban gap in life expectancy and 54% of the life expectancy gap between the urban rich and rural poor.

For each racial/ethnic group, people in rural areas have lower life expectancy than those in urban areas. The largest difference was for American Indians/Alaska Natives. Americans Indians/Alaska Natives have a life expectancy of 85.8 years in urban areas, 11 years more than their counterparts in rural areas. Socioeconomic disparities only partly account for rural-urban disparities in life expectancy. More affluent residents in urban and rural areas have higher life expectancy than their lower-income counterparts. Life expectancy for the rural poor was 74.4 years, compared with 80.6 years for rural rich and 80.7 years for the urban rich. Were any of the findings unexpected?

Answer: Yes. There are dramatic inequalities in life expectancy when you consider race/ethnicity, gender, poverty, and rural-urban populations simultaneously. Life expectancy currently ranges from 67.7 years among poor black/African-American men in non-metropolitan areas to 89.6 among Asian/Pacific Islander women in metropolitan areas – a difference of about 22 years. Moreover, what is surprising is that the rural poor and rural blacks/African-Americans currently experience life expectancy and survival chances that urban rich and urban whites enjoyed four decades earlier. What should clinicians and patients take away from your report?

Answer: Chronic diseases associated with lifestyle factors such as heart disease, respiratory diseases, lung and colorectal cancers, diabetes, and kidney diseases are becoming increasingly important determinants of excess mortality in rural areas and among the rural poor. So, clinicians and patients both need to pay particular attention to adverse health impacts of preventable chronic conditions; behavioral risks such as smoking, physical inactivity, obesity, and poor diet; and lower seatbelt use, inadequate motor-vehicle safety, and faster driving on rural roads. Of course, clinicians and healthcare providers also need to be aware of the role of broader and more upstream social determinants of health (such as education, income, employment, affordable housing, access to food/good nutrition, and opportunities for physical activity); deficits in many of these social resources can put the residents in both rural and urban areas at higher risk of adverse health outcomes, injuries, and lower life expectancy. What recommendations do you have for future research as a result of this study?

Answer: Future research should continue to monitor rural-urban disparities in life expectancy and mortality from major causes of death to see if health disparities are narrowing or widening. Such monitoring is important in that it allows both researchers and policy makers to evaluate if specific social, public-health, and/or medical interventions (such as smoking reduction, anti-obesity measures, and improved healthcare access) are working towards population health improvement in rural areas or reversing the widening health gap between rural and urban areas.


Widening Rural-Urban Disparities in Life Expectancy, U.S., 1969- 2009
Gopal K. Singh, Mohammad Siahpush
American Journal of Preventive Medicine – February 2014 (Vol. 46, Issue 2, Pages e19-e29, DOI: 10.1016/j.amepre.2013.10.017)