An older man in a sweat pants and sweater runs along a city sidewalk.

Americans in rural areas do not live as long as their counterparts in urban areas

New research looks into the growing divide in rural-urban life expectancy.

Americans in urban areas are living longer, on average, than Americans in rural areas, and that divide is growing wider, new research from the University of Texas Medical Branch shows.

In 2005-2009 life expectancy was 78.8 in urban areas compared to 76.8 in rural areas. Then from 2010 to 2019 rural counties experienced declines in life expectancy (-0.20 years for women and -0.30 years for men), while urban counties experienced modest increases (0.55 years for women and 0.29 years for men), according to research by Dr. Neil Mehta, a professor in the Department of Preventive Medicine and Population Health at UTMB, and colleagues.

“Life expectancy in the U.S. was consistently improving until 2010, after which it suddenly stalled due to cardiovascular disease mortality rates,” said Dr. Neil Mehta, co-author of the study and professor in the Department of Preventive Medicine and Population Health at UTMB. “We need to figure out why and make improvements. Because if life expectancy does not increase, it will affect everything in society from families, social security to Medicare.”

Using data from the Centers for Disease Control, researchers at UTMB, Harvard University and Max Planck Institute for Demographic Research measured the contribution of cardiovascular disease, drug overdose deaths, and other major causes of death to life expectancy trends in rural and urban counties.

Published in the International Journal of Epidemiology, the study finds that rural disadvantage in life expectancy continues to grow with cardiovascular disease as the main culprit, even more so than recent increases in drug overdose deaths.

Cardiovascular disease, which includes a number of conditions including heart disease, heart failure, stroke and heart attacks, has been the leading cause of death in the U.S. for decades. Cardiovascular disease mortality rates had been declining thanks to declines in cigarette smoking, improvements in hypertension treatment and lowering circulating cholesterol levels. But around 2010 the rate of cardiovascular disease mortality stopped declining almost entirely, referred to as “cardiovascular disease stagnation,” while improvements in national life expectancy also stalled.

Researchers point out that this stagnation in cardiovascular disease mortality declines contributed to a reversal in life expectancy gains in rural areas, but stagnation was more dramatic in urban areas, slowing down the growth in the rural-urban life expectancy gap. These analyses revealed that if cardiovascular disease mortality had not stagnated, rural life expectancy would have increased by 1.15 years in women and 1.44 years in men during 2010 to 2019.

Further analysis also showed that cardiovascular disease stagnation, particularly in those 65 and older, was the main reason for why rural life expectancy stopped increasing after 2010.

“One of the most important takeaways from the study is that we really need to revisit how we allocate health services in rural areas, where it is especially hard to deliver specialized care like cardiovascular care,” said Dr. Mehta. “Whether that’s mobilizing the public sector, private sectors or a combination, how can we improve health services in rural communities?”

While there is growing concern about increased mortality in older adults, researchers also point out the broad causes of death explain the growing rural-urban divide in life expectancy. The study suggests future research should investigate the contributions of metabolic disorders, smoking, and access to healthcare to stagnation in cardiovascular disease mortality declines. Cardiovascular health promotion efforts need to emphasize on identifying and ameliorating the root causes of persistently high cardiovascular disease death rates in rural areas. These efforts will be essential to improving long-run life expectancy trends in the United States.