Higher US Rural Mortality Rates Linked To Socioeconomic Status, Physician Shortages, And Lack Of Health Insurance
Higher US Rural Mortality Rates Linked To Socioeconomic Status, Physician Shortages, And Lack Of Health Insurance
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DOI：
10.1377/hlthaff.2019.00722
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发表时间：
2019-12-01
期刊：
影响因子：
9.7
通讯作者：
Philips, Billy U.
中科院分区：
文献类型：
--
作者：
Gong, Gordon;Phillips, Scott G.;Philips, Billy U.
自20世纪80年代以来，美国农村地区的全因死亡率一直超过城市地区，而且差距还在继续扩大。然而，这种差异的确切原因尚不清楚，而可能适用于州一级政策的州内差异也没有得到探讨。对2016年州级数据的分析表明，除三个州外，农村死亡率都超过了城市死亡率，各州之间的死亡率差异很大。总体而言，州一级农村死亡率较高主要可以由三个因素解释：社会经济贫困、医生短缺和缺乏健康保险。在一定程度上，这些因素反映了一个国家的卫生政策，如扩大医疗补助的资格，卫生基础设施和社会经济条件。我们的研究结果表明，州和联邦政策努力解决这些地区的城乡差距，可以缓解美国农村居民面临的全因死亡率较高的问题。
All-cause mortality rates in rural areas have exceeded those in urban areas of the US since the 1980s, and the gap continues to widen. Yet no definitive causes of this difference are known, and within-state differences that might be amenable to state-level policy have not been explored. An analysis of 2016 state-level data indicated that rural mortality exceeded urban mortality in all but three states, with substantial variability in both rates across states. Overall, higher rural mortality at the state level can be mainly explained by three factors: socioeconomic deprivation, physician shortages, and lack of health insurance. To a certain degree, these factors reflect a state's health policies, such as expansion of eligibility for Medicaid, health infrastructure, and socioeconomic conditions. Our findings suggest that state and federal policy efforts to address rural-urban disparities in these areas could alleviate the higher rates of all-cause mortality faced by rural US residents.