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Investigation: Deaths due to chronic conditions, ‘death of despair’ rise in rural US



In rural America, more people are dying from chronic health conditions and drug abuse than in suburbs and cities, and the gap is widening.

Researchers report in a new study that the difference in the number of deaths in rural and urban areas has tripled over the last 20 years, mainly due to deaths among middle-aged white men and women.

“We looked at death for all reasons and found that instead of the difference in this difference getting better over time, as one would expect when our economy progresses and our health care system improves, we have actually seen that the differences was really multiplied, “said lead researcher Dr. Haider Warraich, a cardiologist at Brigham and Women̵

7;s Hospital in Boston and VA Boston Healthcare System.

This gap is due in part to access to care, but other factors also contribute, he said.

In terms of access, rural areas have experienced a wave of hospital closures largely driven by economics, particularly during the COVID-19 pandemic, Warraich said.

“But it is difficult to disconnect health from other factors in our society,” he said. “I think it’s linked to the overall economic outlook also in rural America and also health behaviors that contribute to poor health, such as poor nutrition, lack of exercise, smoking, drug use, etc.”

In rural areas, deaths from conditions such as heart and lung diseases as well as so-called “despair deaths” from drugs, alcohol and suicide have increased significantly and are likely to continue to do so, Warraich said.

This is a huge problem, he said, noting that 60 million Americans live in rural areas.

“It’s hard to separate health from the overall economy,” Warraich said. “But I think one thing we really need is to imagine rural health care, really think about what are the things that make effective rural health care – and it’s maybe not just hospitals. . “

It is important to reinforce a lack of high-quality primary and preventive care, he said.

Warraich predicted that health care trends in rural America are likely to spread to suburbs and urban areas.

“Much of what we are already seeing in our society, especially with regard to the challenges of rural America, is a consequence of this public health crisis,” he said.

“I often think there is a feeling that what is happening in these areas remains there and it is not a problem for the rest of the country. It can be harder to ignore as the crisis develops and turns into something, there may be even greater “said Warraich.

Bill Finerfrock, executive director of the National Association of Rural Health Clinics in Alexandria, Va., Said the results are unfortunately not surprising.

“They only serve to strengthen the long-standing understanding that there are ongoing and widespread health disparities between residents and rural areas,” he said.

Finerfrock, who was not part of the study, said that while it did not cite reasons for the sharp differences in deaths, the opioid crisis is likely a factor – especially in rising deaths among rural Americans between the ages of 25 and 64.

He warned that the loss of health clinics as well as hospitals over the last 10 years could make these differences even worse in the coming years.

For the study, Warraich and his colleagues used federal government health data for 1999 through 2019.

They found that age-adjusted deaths fell in both rural and urban areas during that period. But the gap widened dramatically as the death toll among white rural areas rose between 25 and 64.

During the IP, the number of deaths in rural areas increased by 12% for that group. Although the number of deaths fell among black residents in rural areas, they still had a higher death rate than all other groups in both rural and urban areas, researchers noted.

Nationwide, the racial difference in deaths was reduced by half during the period.

The research was published this week in the Journal of the American Medical Association.

Mark Holmes, director of the North Carolina Rural Health Research and Policy Analysis Center in Chapel Hill, also reviewed the results.

“This study adds to existing evidence by showing how individual populations contribute – the fact that, for example, mortality among white rural areas is increasing. The higher mortality rate from COVID-19 in rural areas is another example,” he said.

Breaking down rural areas, as the authors do, can provide a better understanding of causes, Holmes added.

More information

Learn more about differences in rural health care at the Rural Health Information Hub.

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