Study Finds Disparity in Premature Mortality is Widening by Education Level and Rurality but Narrowing by Race

New findings led by researchers atthe American Cancer Society (ACS) show a widening disparity in premature mortality for all causes and the majority of top 10 causes between people in the United States without a college degree compared to college graduates, and people who live in rural areas compared to those who live in urban areas. In contrast, the disparity between Black and White people narrowed for all causes and the 7 top causes for which rates are higher in Black people than White people. The results are published today in the Journal of General Internal Medicine (JGIM).

“All people, regardless of their race, ethnic origin, residence or socio-economic circumstance, deserve an equal opportunity to fulfill their potential for health,” said Dr. Ahmedin Jemal,senior vice president, surveillance & health equity science at the American Cancer Society and senior author of the study. “Unfortunately, from 2007 to 2017, premature mortality widened by education and rural residence. Disparities not only affect socioeconomically disadvantaged populations, but also limits our country’s overall health.”

The study reviewed mortality rates for people between the ages of 25 and 74 for the top 10 causes of death in 2007 and 2017. This includes cancer, heart disease, accidents, chronic lower respiratory diseases, diabetes, cerebrovascular disease, suicide, chronic liver disease and cirrhosis, nephritis, and septicemia. For causes with an overall decreasing trend such as cancer and heart diseases, the decrease was largely confined to the most educated persons, and for those causes with increasing trends, such as accidents and suicide, the increase was confined to or steeper in the less educated people. Likewise, trends in premature mortality were more favorable for urban than rural areas for 9 of the top 10 diseases.

One positive trend – the disparity in premature deaths for all causes and for 7 of the top 10 causes that were higher in Black than White people narrowed during the study period. For many of the causes, the findings in part reflect a greater decline in prevalence cigarette smoking in Black than White people.

The authors state that less educated people, those who live in rural areas, and Black people are more likely to have lower socio-economic status, live in poverty, be uninsured, and lack health care literacy. Even those who are employed often are unable to take time off from work to visit the doctor or care for acute or chronic conditions. They also are more likely to live in neighborhoods that lack grocery stores for fresh fruits and vegetables. In addition, people with lower education and rural residences tend to have higher levels of risk behaviors such as smoking or alcohol use.

“There is a wide range of factors contributing to disparities in premature death rates, but access to and receipt of high-quality care from prevention to treatment and survivorship remains the major contributing factor,” Jemal said. “As a nation, it is critical to our long-term health that we prioritize implementation and dissemination of effective interventions broadly and equitably by improving access to all populations, including expansion of Medicaid in all states.”

Dr. Jiemin Ma is lead author of the study. Other ACS authors on the study include: Dr. Robin Yabroff, and Rebecca L. Siegel.