Age segregation and deaths of despair among older adults, 2010-2022: Rural/Urban county comparisons

Age segregation, the spatial separation of older and younger populations, represents an understudied structural factor linked to health among older adults. By reducing intergenerational contact and increasing isolation, or alternatively fostering bonding ties and access to age-specific resources, age segregation may exert both harmful and protective effects on deaths of despair (DoD) namely suicide-, alcohol- , and drug-related mortality. This study analyzed 40,695 county-year observations from 3133 U.S. counties (2010-2022), drawing on restricted cause-specific mortality outcomes from National Center for Health Statistics and American Community Survey 5-year estimates for age segregation. Age segregation was measured using the dissimilarity index (ages 0-14 vs. 65+). Random-effects Poisson models estimated associations between segregation and each cause of DoD, stratified by rural/urban status. Results indicate that rural counties showed slightly higher DoD mortality rates than urban counterparts. Segregation was positively associated with suicide-related mortality in urban areas (IRR = 1.63, 95% CI: 1.24-2.13) and drug-related mortality in rural areas (IRR = 2.53, 95% CI: 1.30-4.94). DoD surged during 2020-2022, especially drug-related mortality in rural counties. These findings suggest that age-segregated counties are more likely to record higher despair-related mortality among older adults, with heterogeneous patterns across rural and urban contexts.