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Review
. 2021 Jan:268:113443.
doi: 10.1016/j.socscimed.2020.113443. Epub 2020 Oct 23.

The southern rural health and mortality penalty: A review of regional health inequities in the United States

Charlotte E Miller  1 , Ramachandran S Vasan  2
Affiliations
Review

The southern rural health and mortality penalty: A review of regional health inequities in the United States

Charlotte E Miller et al. Soc Sci Med. 2021 Jan.

Abstract

Rural-urban differences in morbidity and mortality across the United States have been well documented and termed the "rural mortality penalty". However, research studies frequently treat rural areas as homogeneous and often do not account for geospatial variability in rural health risks by both county, state, region, race, and sex within the United States. Additionally, people living in the rural South of the US have higher rates of morbidity and mortality compared to both their urban counterparts and other rural areas. Of those living in southern rural communities, people of color experience higher rates of death and disease compared to white populations. Although there is a wealth of research that uses individual-level behaviors to explain rural-urban health disparities, there is less focus on how community and structural factors influence these differences. This review focuses on the "southern rural health penalty", a term coined by the authors, which refers to the high rate of mortality and morbidity in southern rural areas in the USA compared to both urban areas and non-southern rural places. We use macrosocial determinants of health to explain possible reasons for the "southern rural health penalty". This review can guide future research on rural health between southern and non-southern populations in the US and examine if macrosocial determinants of health can explain health disparities within southern rural populations.

Keywords: Macrosocial determinants of health; Race-specific mortality; Regional health disparities; Rural; Rural health; Rural mortality penalty; U.S. south.

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Figures

Figure 1:
Figure 1:. Displays the growth of the registration area for deaths in the United States of America
Source: (U. S. National Center for Health Statistics (US). National Vital Statistics Division, & United States Bureau of the Census, Vital Statistics Division., 1932)
See this image and copyright information in PMC

References

Bibliography

    1. Auchincloss AH, & Hadden W (2002). The Health Effects of Rural-Urban Residence and Concentrated Poverty. Journal of Rural Health, 18(2), 319–336. doi:10.1111/j.1748-0361.2002.tb00894.x - DOI - PubMed
    1. Bailey ZD, Krieger N, Agenor M, Graves J, Linos N, & Bassett MT (2017). Structural racism and health inequities in the USA: evidence and interventions. The Lancet, 389(10077), 1453–1463. doi:10.1016/S0140-6736(17)30569-X - DOI - PubMed
    1. Barnidge EK, Radvanyi C, Duggan K, Motton F, Wiggs I, Baker EA, & Brownson RC (2013). Understanding and addressing barriers to implementation of environmental and policy interventions to support physical activity and healthy eating in rural communities. J Rural Health, 29(1), 97–105. doi:10.1111/j.1748-0361.2012.00431.x - DOI - PMC - PubMed
    1. Bauer E (2010). Vision 2020-Rural Health: The Startling Statistics September-October 2010. - PubMed
    1. Boehmer TK, Lovegreen SL, Haire-Joshu D, & Brownson RC (2006). What constitutes an obesogenic environment in rural communities? Am J Health Promot, 20(6), 411–421. doi:10.4278/0890-1171-20.6.411 - DOI - PubMed

Appendix Bibliography

    1. National Center for Health Statistics (US). National Vital Statistics Division, U. S., & United States Bureau of the Census, Vital Statistics Division. (1890–1938). Vital Statistics of the United States: 1890–1938. Retrieved from https://www.cdc.gov/nchs/products/vsus/vsus_1890_1938.htm
    1. National Center for Health Statistics (US). National Vital Statistics Division, U. S., & United States Bureau of the Census, Vital Statistics Division. (1939–1964). Vital Statistics of the United States: 1939–1964. Retrieved from https://www.cdc.gov/nchs/products/vsus/vsus_1939_1964.htm
    1. National Center for Health Statistics (US). National Vital Statistics Division, U. S., & United States Bureau of the Census, Vital Statistics Division. (1902). Twelfth Census of the United States, Taken in the Year 1900. Volume III. Part I. Analysis and Ratio Tables Retrieved from https://www.cdc.gov/nchs/data/vsushistorical/vsush_1900_3.pdf
    1. National Center for Health Statistics (US). National Vital Statistics Division, U. S., & United States Bureau of the Census, Vital Statistics Division. (1923). Mortality Rates 1910–1920. With Population of the Federal Censuses of 1910 and 1920 and Intercensal Estimates of the Population Retrieved from https://www.cdc.gov/nchs/data/vsushistorical/mortrates_1910-1920.pdf
    1. National Center for Health Statistics (US). National Vital Statistics Division, U. S., & United States Bureau of the Census, Vital Statistics Division. (1927). Mortality Statistics 1925. Twenty-Sixth Annual Report. Part I. Summary and Rate Tables and General Tables for the Death Registration Area in Continental United States, with Supplemental Statistics for Hawaii and the Virgin Islands Retrieved from https://www.cdc.gov/nchs/data/vsushistorical/mortstatsh_1925.pdf