Databyte

Cancer Survival Is (Mostly) Improving

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                    [post_date] => 2019-04-10 07:00:29
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                    [post_content] => The five-year survival rates for the most common cancers in the US improved by nearly 20% (first line of the graph above) since the 1970s. While promising overall, low survival rates persist for pancreatic, liver, lung, esophageal, brain, and many others. Five-year survival for uterine and cervical cancers even decreased, and researchers aren’t sure why.

Lung cancer remains the most common type of cancer across the globe with nearly 2.1 million diagnoses worldwide. In the US, approximately 234,000 Americans were diagnosed in 2018. Despite its extremely high prevalence, only 18.1 percent of individuals with a lung cancer diagnosis (up from 12.2 percent) are expected to reach their five-year survival mark.

Pancreatic cancer has the lowest five-year survival rate at 8.2 percent.

In contrast, prostate cancer had the greatest five-year survival increase from 67.8 percent to 98.6 percent, most likely reflecting a substantial uptick in prostate cancer screenings and early detection. Of the 165,000 Americans diagnosed with prostate cancer in 2018, 98.6 percent are expected to reach the five-year mark.

Five-year survival with leukemia also improved significantly from 34.2 percent to 60.6 percent, likely resulting from improved treatment methods.

In both detection and treatment, we’re making progress. For the millions of Americans who face a cancer diagnosis, this is cause for hope.

Figure by Max Roser and Hannah Ritchie,"Cancer," 2019.
                    [post_title] => Cancer Survival Is (Mostly) Improving
                    [post_excerpt] => Cancer is slowly releasing its grip and the survival rates are increasing. Data presented show the 5-year survival rates for common cancers.
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Cancer is slowly releasing its grip and the survival rates are increasing. Data presented show the 5-year survival rates for common cancers.

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Databyte

Documenting Delays in EMS Wait Times

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                    [post_date] => 2019-04-09 07:00:04
                    [post_date_gmt] => 2019-04-09 11:00:04
                    [post_content] => How long do you think it takes for an ambulance to respond to a 9-1-1 call and get a patient to a hospital? In a recent study, Renee Y. Hsia and colleagues assessed 63,000 cardiac arrest EMS encounters to determine whether ambulance response times were longer in low-income versus high-income urban zip codes. The graph above displays three measures, comparing low-income and high-income neighborhoods: 1) the time in minutes between EMS dispatch to arrival at the patient’s location (Response Time), 2) the time between EMS arrival and departure (On-Scene Time), and 3) the time between scene departure and arrival at the destination hospital (Transport Time).

The total EMS time (Response + On-Scene +Transport) for low-income communities was 3.8 minutes (10%) longer than in high-income neighborhoods. The gap in time between the two areas is largely attributable to On-Scene Time, which was 2.8 minutes (15%) longer in low-income zip codes. The authors do not give insight as to why on-scene time has the biggest gap in time, but possible barriers impeding immediate care from EMTs in low-income neighborhoods might include congested streets, narrow doorways, and buildings without elevators. The authors cite several additional barriers such as scene safety and distance from a hospital that may have contributed to the differences in total time.

This study is one of the first to document delays in EMS care by zip code. Although a few minutes may not appear to be an important difference, survival or death may be determined in a matter of minutes. The authors note that cardiac care delayed by just one to four minutes has been associated with increased mortality.

Figure via “A US National Study of the Association Between Income and Ambulance Response Time in Cardiac Arrest,” JAMA Network Open. 2018;1(7):e185202.
                    [post_title] => Documenting Delays in EMS Wait Times
                    [post_excerpt] => One of the first studies to document delays in EMS care asks whether ambulance response times were longer in low-income versus high-income urban zip codes.
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One of the first studies to document delays in EMS care asks whether ambulance response times were longer in low-income versus high-income urban zip codes.

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Databyte

Direct-to-Docs Opioid Marketing

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                    [post_date] => 2019-03-28 07:00:59
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                    [post_content] => One factor that has fueled the current addiction epidemic is the pharmaceutical industry’s direct-to-physician marketing of opioids. To promote new drugs, pharmaceutical companies often market their products to physicians by providing industry-sponsored meals, grants, and subsidies for continued medical education and training. Physicians have also received fees for consulting or speaking publicly about opioid products, which could increase prescriptions among their peers.

A recent study sought to understand the relationship between mortality from opioid overdose and the pharmaceutical industry’s direct marketing of opioids to physicians. The study analyzed the association between three factors in every US county: the amount of marketing payments pharmaceutical companies made to physicians, opioid prescribing rates, and the number of overdose deaths. 

Researchers found that direct marketing of opioids to physicians was associated with increased opioid prescribing rates and increased overdose mortality one year after marketing engagements. Figure 1 illustrates the number of physicians who received direct marketing between 2013 and 2015. Figure 2 highlights overdose mortality rate across the US one year later (2014-2016). Higher prescribing rates facilitated the link between opioid marketing to physicians and mortality from overdoses.

The national response to the opioid epidemic has focused in part on reducing the number of opioids prescribed by physicians. Additionally, the Physician Payments Sunshine Act promotes financial transparency between pharmaceutical companies and healthcare providers. The Act requires any payments between both entities to be reported to the Centers for Medicaid and Medicare Services. States that have additional reporting requirements or limitations beyond those stipulated by the Physician Payments Sunshine Act include Vermont, Massachusetts, Minnesota, Washington DC, West Virginia, California, Connecticut, Louisiana, and Nevada.

By increasing regulation around pharmaceutical direct-to-physician marketing and making pharmaceutical company payments to physician available to the public, states have the potential to reduce overdose mortality.

Figures via "Association of Pharmaceutical Industry Marketing of Opioid Products With Mortality From Opioid-Related Overdoses," JAMA Network Open. 2019;2(1):e186007. doi:10.1001/jamanetworkopen.2018.6007. 
                    [post_title] => Direct-to-Docs Opioid Marketing
                    [post_excerpt] => Pharmaceutical industries are marketing opioids directly to physicians. How much of it contributes to current opioid addiction epidemic?
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Pharmaceutical industries are marketing opioids directly to physicians. How much of it contributes to current opioid addiction epidemic?

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Databyte

Scooter Safety

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                    [post_date] => 2019-03-26 07:00:05
                    [post_date_gmt] => 2019-03-26 11:00:05
                    [post_content] => Dockless, electric scooters are popping up across the country. Electric scooter sharing offers a convenient, low-cost, means of transportation. Riders simply download the app for a scooter company that operates in their city, use the app to locate and activate a nearby scooter, and park it anywhere when they are done. The concept is comparable to bike sharing.

Lime-S scooters are available in more than 60 US cities, and, in April 2018, Bird Rides, Inc, announced more than 1 million completed rides. Concern for scooter rider, pedestrian, and motorist safety is growing as electric scooter sharing proliferates as a popular means of transportation.

Dr. Tarak Trivedi and researchers from UCLA reviewed injuries affiliated with electric scooter use to observe rider practices and injury characteristics. The study investigated the records of 249 patients injured by scooters seen over one year in emergency departments in Southern California. Ninety two percent (228) were injured while riding a scooter. As the figure shows, the most common injuries were head trauma, bone fractures, and soft tissue damage like cuts, sprains, and bruises. Only 4% of the injured riders were wearing a helmet.

Scooter rental companies like JUMP require riders to be 18 years or older with a valid driver’s license. These companies also urge several safety recommendations, including wearing a helmet. The company Bird encourages riders to wear a helmet by offering free helmets to active riders. However, as this study points out, no uniform set of policies at the state or city level regarding electric scooters exists.

Atlanta recently passed a law confining scooter riders to the streets, bike lanes, and shared-use paths. Helmet use, however, is only recommended, not required. California requires riders to possess a California driver’s license or instruction permit and wear a helmet if they’re under 18 years of age. Riding on sidewalks is prohibited. Trivedi and colleagues note that it is “unclear” how California’s policy change will affect rider practices and injury patterns.

Image from Niall McCarthy, Statista
                    [post_title] => Scooter Safety
                    [post_excerpt] => Researchers review injuries caused by electric scooters in Southern California to study the rising concerns for pedestrians and motorist safety. 
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Researchers review injuries caused by electric scooters in Southern California to study the rising concerns for pedestrians and motorist safety.

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Databyte

The Remaining Uninsured Americans

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                    [post_date] => 2019-03-22 05:00:16
                    [post_date_gmt] => 2019-03-22 09:00:16
                    [post_content] => The Affordable Care Act (ACA) has survived 70 repeal attempts and wavering public support. In the eight years since its passage, approximately 20 million Americans have gained health insurance coverage through either the private marketplace or state-based Medicaid expansion. However, the uninsured rate is still nine percent nationally, so it is important to look at where further improvements are possible.

The figure above, from the Kaiser Family Foundation, reveals racial disparities in health insurance coverage among non-elderly adult and children. Although all races saw decreases in the uninsured rate between 2013 and 2016, Hispanic and Black adults are still more likely to be uninsured compared to their White counterparts.

In 2016, Hispanic and Black adults were also less likely than White adults to have private insurance and more likely to use Medicaid or Medicare. Despite significant gains in coverage for Hispanic adults, 22 percent remain uninsured. And unfortunately, many of the uninsured Black adults live in states that have yet to expand Medicaid, which also limits their options.
For both adults and children, racial disparities in health insurance coverage persist. Given the ongoing attacks on the ACA, these disparities are unlikely to be meaningfully addressed in the near future.  
Hispanic and Black children, too, have higher uninsured rates than White children, though the magnitude of the difference is less than the adult population. This lower magnitude can largely be attributed to coverage through the Children’s Health Insurance Program, which provides low-cost health insurance to families whose income is too high to qualify for Medicaid. For both adults and children, racial disparities in health insurance coverage persist. Given the ongoing attacks on the ACA, these disparities are unlikely to be meaningfully addressed in the near future. Over the last two years, the Trump administration has spent less money to advertise how and when Americans can find insurance coverage and has failed to assist those seeking coverage through the ACA marketplace. Meanwhile, 15 states have either applied for or enacted work requirements for Medicaid, creating another barrier to accessing insurance. At least for now, health care in the United States very much remains a privilege and not a right. Image: "Changes in Health Coverage by Race and Ethnicity since Implementation of the ACA, 2013-2017," Samantha Artiga, Kendal Orgera, and Anthony Damico, 2019 [post_title] => The Remaining Uninsured Americans [post_excerpt] => Disparities in health insurance coverage persist. Hispanic and Black adults are still more likely to be uninsured compared to their White counterparts. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => the-remaining-uninsured-americans [to_ping] => [pinged] => [post_modified] => 2019-04-04 14:27:49 [post_modified_gmt] => 2019-04-04 18:27:49 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_databyte&p=6487 [menu_order] => 0 [post_type] => bu_databyte [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

Disparities in health insurance coverage persist. Hispanic and Black adults are still more likely to be uninsured compared to their White counterparts.

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Databyte

Income Inequality Between Black and White Males

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                    [post_date] => 2019-03-20 07:00:44
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                    [post_content] => The uneven distribution of income is a key contributor of economic injustice in the US. Income inequality is influenced by policy, education, and globalization, among other factors. Raj Chetty and colleagues, in collaboration with the US Census Bureau, studied race and intergenerational earnings, important contributors to income inequality, as part of the Opportunity Insights project.

Black Americans have lower rates of upward mobility and higher rates of downward mobility than Whites. The figure above shows gaps in income ranks for Black and White males in adulthood, juxtaposed with the income of their parents. The image displays that on average, neither Black or White males reach the income level of their parents. The gap between Black and White males’ earnings is especially stark. One finding is particularly striking: even when they grow up in households with comparably high incomes, black males earn less than White males in adulthood.

Take a look at the parent household income rank at the 75th percentile. When White male children with parental income at the 75th percentile become income-earning adults, their average income rank falls to the 64th percentile. When Black male children with parental income at the 75th percentile become income earning adults, their average income rank falls to the 52nd percentile.

The Black-White income gap dependent on parental earnings in the US is driven by the difference in income outcomes of Black and White males. According to the study no such gaps are evident between Black and White women.

Areas with the smallest Black-White male income gaps tend to be low-poverty neighborhoods with low levels of racial bias among Whites, and high rates of father presence among Blacks. The question then becomes, how do we replicate these conditions across the entire country to narrow gaps in income and improve the overall quality of life for Black men? The authors call attention to endeavors, such as Black male role models mentoring boys in their communities, that offer an opportunity to increase upward mobility across generations.

Image: Opportunity Insights, Race and Economic Opportunity in the United States: An Intergenerational Perspective, by Raj Chetty, Nathaniel Hendren, Maggie R. Jones, Sonya R. Porter, March 2018
                    [post_title] => Income Inequality Between Black and White Males
                    [post_excerpt] => If uneven distribution of income is a key contributor of economic injustice, how do we replicate conditions to narrow gaps in income for Black men?
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If uneven distribution of income is a key contributor of economic injustice, how do we replicate conditions to narrow gaps in income for Black men?

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Databyte

Un-Wellbeing

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                    [post_date] => 2019-03-19 07:00:16
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                    [post_content] => In recent years, wellbeing has become an important topic in discussions about health. As society embraces a definition of health beyond the absence of disease, more people are recognizing the critical role of emotional, psychological, and social wellbeing in leading a fulfilling life.

The Gallup-Sharecare Well-Being Index measures Americans' perceptions of their lived experiences by measuring sense of purpose, social relationships, financial security, relationship to community, and physical health. Index scores fall between 0 (the lowest possible score) and 100 (the highest score attainable). Since the index began in 2008, the overall score for wellbeing in the US has remained relatively stable.

2017 marked the first time no state reported an improvement in wellbeing from the year before. The map shows that 21 states experienced a decline in wellbeing while scores for the remaining 29 states remained unchanged. Nationally, the wellbeing index score was 61.5—the lowest in the index’s history.

South Dakota, Vermont, and Hawaii ranked the highest in wellbeing, while Arkansas Louisiana, and West Virginia ranked lowest.

Sense of purpose and social wellbeing were indicators mostly responsible for declines. This was reflected in an overall decrease in satisfaction with standard of living and an increase in clinical diagnoses of depression.

Greater wellbeing facilitates better performance at work and stronger relationships with family and friends. As such, the result of the Index report underscores the need to improve the wellbeing of Americans by fostering opportunities that promote purposeful engagement and strengthen mental health services.

Image from “Record 21 Sates See Decline in Well-being in 2017," Gallup, 2017. 
                    [post_title] => Un-Wellbeing
                    [post_excerpt] => 2017 marked the first time no state reported an improvement in wellbeing from the year before according to the Gallup-Sharecare Well-Being Index.
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2017 marked the first time no state reported an improvement in wellbeing from the year before according to the Gallup-Sharecare Well-Being Index.

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Databyte

Transgender Individuals See Improvements in HIV Outcomes

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                    [post_date] => 2019-03-06 07:00:02
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                    [post_content] => CD4 counts are an indication of immune system function, with a higher CD4 count indicating better health. A normal CD4 count ranges from 500-1500. When someone with HIV has a CD4 count of less than 200, they are diagnosed with AIDS.

Researchers at the Division of Disease Control in New York City used HIV surveillance data to assess the CD4 counts of cisgender and transgender people living with HIV. The graph above compares the percentages of HIV-positive cisgender women, cisgender men, and transgender people with CD4 counts above 500 in between 2007 and 2016.

The percentage of HIV-positive cisgender people who had a CD4 count higher than 500 increased from 38% in 2007 to 61%. Among transgender people with HIV, CD4 counts over 500 increased from 32% to 60% in the same time frame, narrowing the gap between the two populations.

Several factors may have played a role in these CD4 count improvements. Greater insurance coverage of antiretroviral medications may have increased access to life-saving treatment, and decreasing stigma in health care settings could have lead to greater adherence to treatment among transgender persons.

Design: David Gaitsgory @dgaitsgo. Source: “Reduction in Gaps in High CD4 Count and Viral Suppression Between Transgender and Cisgender Persons Living With HIV in New York City, 2007–2016,” by Qiang Xia, Selam Seyoum, Ellen W. Wiewel, Lucia V. Torian, Sarah L. Braunstein, American Journal of Public Health 109, no. 1 (January 1, 2019): pp. 126-131. DOI: 10.2105/AJPH.2018.304748
                    [post_title] => Transgender Individuals See Improvements in HIV Outcomes
                    [post_excerpt] => Researchers assessed the CD4 counts of cisgender and transgender people living with HIV and showed a narrowing of the gap between two populations.
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Researchers assessed the CD4 counts of cisgender and transgender people living with HIV and showed a narrowing of the gap between two populations.

...more
Databyte

I Would if I Could: Bike Share

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                    [post_date] => 2019-02-14 07:00:43
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                    [post_content] => Bike share programs are booming. Present in over 100 cities across the US, bike sharing is an inexpensive form of transportation that can save time during a commute, while also offering numerous health benefits.

However, a disproportionate amount of city residents who participate are White and high-income. But it’s not a lack of interest keeping lower-income residents and people of color from participating. Rather, several barriers block access for underserved and underrepresented groups, including cost, lack of bike stations in low-income neighborhoods, lack of bank accounts, and lack of familiarity with bike share.

In 2015, Better Bike Share Partnership (BBSP) provided funding to six cities in efforts to increase access to bike share in low-income and underserved communities. They went on to co-fund a study with the National Institute for Transportation and Communities at Portland State University to research how BBSP interventions impacted bike share use in Chicago, Philadelphia, and Brooklyn. The study measured ongoing barriers by collecting user and non-user perceptions towards bike share in BBSP target neighborhoods.
The team collected 1,885 responses and compared the results of four demographic groups: higher-income people of color, lower-income people of color, higher-income white, and lower-income white residents.  
English and Spanish surveys were sent out to communities in Chicago, Philadelphia, and Brooklyn. Race/ethnicity was self-reported; individuals were divided into higher- and lower-income categories based on their household income (either over or under 150% of the poverty level). The team collected 1,885 responses and compared the results of four demographic groups: higher-income people of color, lower-income people of color, higher-income white, and lower-income white residents. Reported barriers are represented in the word-cloud graphic above; the bolder the font, the more often it was reported. The cost of a membership was a barrier for almost half of the lower-income residents of color. Over 50% of lower-income residents of color were concerned about damaging the bike and being held liable. Having to use a credit card was a barrier for over a quarter of lower-income residents of color (37%), as was unfamiliarity with the system (34%). The most common barrier reported by lower- and higher-income white residents was a preference for riding their own bike (45%). Lower-income white residents also cited cost and availability as barriers to using bike share. People’s enthusiasm for bike share, however, was not lost in the face of these barriers. The majority of residents expressed a liking for the system, and strong interest to utilize it. Even though almost all of the survey residents reported seeing a bike share in their neighborhood, unfamiliarity with using the bike share was found to be an overall barrier. Two-thirds of the surveyed respondents reported that they would be more likely to use bike share if discounted membership rates were available. Bike share programs in all three cities have cash-payment or reduced-fee options to help make it more affordable. If bike share programs could implement strategies to spread awareness of the affordability and simplicity of use, there’s a good chance more people would use them. Image from "Breaking Barriers to Bike Share: Insights from Residents of Traditionally Underserved Neighbourhoods" Natham McNeil, Jennifer Dill, John MacArthur, Joseph Broach, Steven Howland. NITC-RR-884b. Portland, OR: Transportation Research and Education Center (TREC), 2017. doi: 10.15760/trec.176 [post_title] => I Would if I Could: Bike Share [post_excerpt] => Better Bike Share Partnership increased access to bike share programs in low-income and underserved communities in six cities. This study assessed ongoing barriers to use in Chicago, Philadelphia, and Brooklyn. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => i-would-if-i-could-bike-share [to_ping] => [pinged] => [post_modified] => 2019-02-14 22:31:41 [post_modified_gmt] => 2019-02-15 03:31:41 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_databyte&p=6304 [menu_order] => 0 [post_type] => bu_databyte [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

Better Bike Share Partnership increased access to bike share programs in low-income and underserved communities in six cities. This study assessed ongoing barriers to use in Chicago, Philadelphia, and Brooklyn.

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Databyte

Rural Living and Dying

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                    [post_content] => For the past few decades, nonmetropolitan areas have been facing a phenomenon called the “rural mortality penalty.” This penalty was once associated with cities, as crowding and poor sanitation helped contagious diseases spread quickly in urban environments. But this burden has shifted to rural areas over the last 40 years. The difference between urban and rural excess deaths, or the number of deaths that exceed the predicted amount each year, grew almost ten-fold from the 1980s to the early 2000s. Further, the death rate in the US in 2014 was the lowest in the country’s history, yet rural deaths by cancer and heart-disease between 1999 and 2014 declined at a slower rate than those in urban areas.

A new report in the American Journal of Public Health highlights changes in death rates in the United States between 1970 and 2016. The researchers consistently found poverty, education, race, and income to be associated with deaths by all causes over the 47-year study period.

The breakdown of mortality by poverty levels in urban and rural areas is depicted in the figure above. Rural high poverty areas had the highest mortality rates in 2016, at 900 deaths for every 100,000 people, and urban low poverty areas had the lowest rates, at 700 deaths for every 100,000 people. This gap in 2016 between the two areas is the widest since 1970. Looking specifically within rural areas, the gap between high and low poverty areas is also the widest it has been since 1970, with a difference of around 150 deaths per 100,000 people.

The rural mortality penalty that first became evident in the 1980s continues to exist, and seems to impact high-poverty rural areas the most. Rural America may be at particular risk because healthcare is more limited than in urban America.

Graph: Figure 4—Trends in Age-Adjusted All-Cause Mortality Rates for Rural, High-Poverty Counties; Rural, Low-Poverty Counties; Urban, High-Poverty Counties; and Urban, Low-Poverty Counties: United States, Centers for Disease Control and Prevention WONDER, 1970–2016, American Journal of Public Health. 2019;109:155–162. doi:10.2105/AJPH.2018.304787
                    [post_title] => Rural Living and Dying
                    [post_excerpt] => There is a widening gap in US rural and urban death rates. Researchers report that these changes are not sudden and have been happening since 1970.
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There is a widening gap in US rural and urban death rates. Researchers report that these changes are not sudden and have been happening since 1970.

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