03 Aug Racial Health Gap Widening in Rural America

MedicalResearch.com Interview with:

Dr. Ferdows

Nasim B. Ferdows, Ph.D.
Assistant Professor, Department of Health Administration and Policy
Hudson College of Public Health
The University of Oklahoma Health Sciences Center
Oklahoma City, OK

MedicalResearch.com: What is the background for this study?

Response: This half a century study of US senior men and women who died between 1968 and 2016 shows how disparities in the Black and White mortality of older US citizens have changed over time, as well as how the racial disparities differ in rural, suburban and urban areas.

MedicalResearch.com: What are the main findings?

Response: This study indicates that the differences among Black and White older adult’s mortality rate have narrowed in the urban areas; however, there is considerable widening in mortality rate among Black and White men living in rural and suburban areas. Notably, the current mortality rate of Black men living in rural areas is like that of White men living in urban and rural areas in the mid-1980s.

Beside the racial disparities, there is a considerable difference in mortality rates among rural and suburban vs urban residents within each race and gender group. The rural and suburban vs urban disparities persist for Black men even after considering county characteristics but fades away for other groups.

MedicalResearch.com: What should readers take away from your report?

Response: The racial gap is widening in rural America. Chronic disease is a huge concern to rural healthcare system, and its impact on mortality is profound in older black rural residents. Thus, there is double burden on Black rural residents: Rural older black Americans are a at high risk population who experience significant health disparities and bias in access to health care along with high prevalence of multiple chronic conditions.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: “Although the more recent studies on mortality rate disparities between Blacks and Whites indicate a closing gap in racial disparities, this study shows that the gap is widening in rural areas, especially for the Black men population.  Future studies on racial disparities in health outcomes should consider geographical characteristics, specifically rurality of the place of residence, as one of the main predictors of the differences,” said Dr. Ferdows, an Assistant professor at the University of Oklahoma Health Sciences Center.

MedicalResearch.com: Is there anything else you would like to add?

Response: Our results highlight the importance of understanding the trends in mortality rates by race, sex, and geographic area. These data can be used by policymakers to understand intersectional factors in mortality disparities as a starting point for public health and clinical interventions aimed at reducing disparities in rural regions, especially among older Black adults.

There is some level of healthcare disparity and bias in healthcare delivery which restricts rural residents from optimizing their health outcomes. Beside the long-lasting shortage of physicians in rural areas, we have witnessed the closure of several hospitals and nursing homes in rural areas in the past ten years. Individuals with cardiovascular disease are in need to receive care more regularly compared to others. Living in rural areas makes it difficult for them to access the care they need.  African Americans have higher risk of cardiovascular disease, and because of lower access to healthcare services in rural areas African Americans living at rural areas are at higher risk,” said Dr. Kumar, an Assistant Professor at Northern Arizona University.

Policy makers should address this and take steps. Prior studies have shown that Residents of rural areas in the United States tend to be older and sicker than their urban counterparts. They have higher rates of cigarette smoking, high blood pressure, and obesity. Rural residents report less leisure-time physical activity than their urban counterpart. At population level all these should be preventable by state and federal public health policies and health education. 

Citation: 

Ferdows NB, Aranda MP, Baldwin JA, Baghban Ferdows S, Ahluwalia JS, Kumar A. Assessment of Racial Disparities in Mortality Rates Among Older Adults Living in US Rural vs Urban Counties From 1968 to 2016. JAMA Netw Open. 2020;3(8):e2012241. doi:10.1001/jamanetworkopen.2020.12241 

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Last Updated on August 3, 2020 by Marie Benz MD FAAD