Trends in US Working-Age non-Hispanic White Mortality: Rural-Urban and Within-Rural Differences
Trends in US Working-Age non-Hispanic White Mortality: Rural-Urban and Within-Rural Differences
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DOI：
10.1007/s11113-020-09607-6
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发表时间：
2020-09-04
影响因子：
2.4
通讯作者：
Monnat, Shannon M.
中科院分区：
文献类型：
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作者：
Monnat, Shannon M.
在美国农村地区的死亡率比城市地区低或相当的几十年后，许多研究记录了农村的死亡惩罚，这种惩罚始于1990年代，自2000年代中期以来有所增加。差距的扩大似乎在非西班牙裔白人中尤为明显。然而，美国农村地区并非铁板一块，在过去30年里，一些农村地区的死亡率增长幅度比其他地区大得多。利用国家生命统计系统（NVSS）的限制性死亡率文件，我研究了1990-2018年工作年龄（25-64）NH白色男性和女性的地铁与非地铁和非地铁内（分区和经济依赖）全因和特定原因死亡率趋势。结果表明，非地铁死亡惩罚是广泛的和不断增长的，是在多个疾病和伤害类别普遍存在。女性的趋势尤其令人担忧。癌症和心血管疾病死亡率的小幅下降（整个20世纪90年代和21世纪初）以及代谢和呼吸系统疾病、自杀、酒精相关和精神/行为障碍的大幅增加（整个21世纪10年代）共同推动了非地铁劣势的增长。也存在很大的分区差异（女性的差异正在扩大），新英格兰、南大西洋、东南中部、西南中部和阿巴拉契亚的趋势尤其糟糕，而大西洋中部、山区和太平洋地区的趋势更为有利。自2000年代中期以来，由于多种死亡原因，依赖采矿业的县与其他经济依赖型县不同，而农业县的死亡率相对较低。各种原因和农村地区的高死亡率和不断上升的死亡率-其中一些是自1990年代以来发生的，另一些是最近出现的-表明没有一个根本的解释。相反，各种机构和政策的系统性失败导致了美国农村令人不安的死亡率趋势，更具体地说，是农村内部的差异。
After decades of lower or comparable mortality rates in rural than in urban areas of the U.S., numerous studies have documented a rural mortality penalty that started in the 1990s and has grown since the mid-2000s. The widening of the gap appears to be especially pronounced among non-Hispanic (NH) whites. However, the rural U.S. is not monolithic, and some rural places have experienced much larger mortality rate increases than others over the past 30 years. Drawing on restricted mortality files from the National Vital Statistics System (NVSS), I examine metro versus nonmetro and intra-nonmetro (divisional and economic dependency) all-cause and cause-specific mortality trends among working-age (25-64) NH white males and females, 1990-2018. Results show that the nonmetro mortality penalty is wide and growing and is pervasive across multiple disease and injury categories. Trends for females are particularly concerning. Smaller nonmetro declines in mortality from cancers and cardiovascular disease (throughout the 1990s and 2000s) and larger increases in metabolic and respiratory diseases, suicide, alcohol-related, and mental/behavioral disorders (throughout the 2010s) collectively drove the growth in the nonmetro disadvantage. There are also large divisional disparities (which are growing for females), with particularly poor trends in New England, South Atlantic, ES Central, WS Central, and Appalachia and more favorable trends in the Mid-Atlantic, Mountain, and Pacific. Mining-dependent counties have diverged from the other economic dependency types since the mid-2000s due to multiple causes of death, whereas farming counties have comparatively lower mortality rates. High and rising mortality rates across a variety of causes and rural places, some of which have been occurring since the 1990s and others that emerged more recently, suggest that there is not one underlying explanation. Instead, systemic failures across a variety of institutions and policies have contributed to rural America's troubling mortality trends generally and within-rural disparities more specifically.