Underlying causes of the emerging nonmetropolitan mortality penalty

Abstract

The nonmetropolitan mortality penalty results in an estimated 40 201 excessive US deaths per year, deaths that would not occur if nonmetropolitan and metropolitan residents died at the same rate. We explored the underlying causes of the nonmetropolitan mortality penalty by examining variation in cause of death. Declines in heart disease and cancer death rates in metropolitan areas drive the nonmetropolitan mortality penalty. Future work should explore why the top causes of death are higher in nonmetropolitan areas than they are in metropolitan areas.

FIGURE 1

Metropolitan-to-nonmetropolitan mortality rate ratio: National Center for Health Statistics Compressed Mortality File, 1968–2015. Note. Heart disease deaths were included if the International Classification of Diseases, Adapted for Use in the United States, Eighth Revision (ICDA-8), recode was between 310 and 400 (1968–1978), if the International Classification of Diseases, Ninth Revision (ICD-9), recode was between 320 and 410, or if the International Classification of Diseases, 10th Revision (ICD-10), recode was between 53 and 68. Comparable recodes for stroke were 410 to 480 (ICDA-8), 420 to 490 (ICD-9), and 70 to 75 (ICD-10). For cancer deaths, the recodes were 15 to 240 (ICDA-8), 160 to 250 (ICD-9), and 19 to 44 (ICD-10).