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. 2017 Jul 29:3:618-623.
doi: 10.1016/j.ssmph.2017.07.013. eCollection 2017 Dec.

The differential effects of rural health care access on race-specific mortality

Jeralynn Cossman  1 , Wesley James  2 , Julia Kay Wolf  1
Affiliations

The differential effects of rural health care access on race-specific mortality

Jeralynn Cossman et al. SSM Popul Health. .

Abstract

We examined the relationship between race-specific rural mortality and the health infrastructure of rural counties in light of America's recent emergence of a rural mortality penalty. Using the Compressed Mortality File from National Center for Health Statistics (2008-2012) and county-level demographic, socioeconomic, and health care indicators from the Area Health Resource File and the US Census, we created a rural public health infrastructure index which encompasses four types of health care access (public health employees, critical access hospital/rural referral centers, rural health clinics, and emergency departments) within counties. We found that each unit increase in the index is associated with a decline in rural Black mortality, but is associated with an increase in rural White mortality. Policymakers could benefit from focusing on the declining rate of mortality improvement in many rural regions, specifically by trying to better understand how decisions concerning public health spending may influence mortality differently for Black and White residents.

Keywords: CAH, critical access hospitals; Health infrastructure; MSA, metropolitan statistical area; PCMH, patient centered medical home; RUCCs, rural-urban continuum codes; Race-specific mortality; Rural mortality penalty; Spatial mortality disparities.

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Figures

Fig. 1
Fig. 1
Urban-Rural Mortality Rates by Race, 1968–2012.
See this image and copyright information in PMC

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