Rural health disadvantages in the United States: Evidence from nationally representative data
Brandon J Restrepo1, Elizabeth A Dobis2, Sarah A Low3
1Diet, Safety, and Health Economics Branch, Food Economics Division, Economic Research Service, US Department of Agriculture, 1400 Independence Ave SW, Washington, DC 20250, United States.
Economics and Human Biology
|June 24, 2026
Summary
Rural residents face higher mortality rates than urban counterparts, a gap widening since the late 1990s, especially for working-age adults. County-level factors significantly influence these health disparities.
Area of Science:
- Public Health
- Rural Health Disparities
- Health Economics
Background:
- A significant rural-urban mortality gap emerged in the late 1990s, disproportionately affecting prime working-age adults.
- This disparity has been widening, with limited understanding of underlying health mechanisms.
- Rural health, productivity, and economic development are impacted by this growing longevity gap.
Purpose of the Study:
- To investigate the health-related mechanisms driving the widening rural-urban mortality gap.
- To analyze rural health disadvantages using a comprehensive dataset.
- To determine the influence of county-level characteristics on rural health outcomes.
Main Methods:
- Utilized nationally representative data from the National Health and Nutrition Examination Survey (1999-2020).
- Combined individual-level data (including biomarkers) with place-based characteristics.
- Employed linear regression models for descriptive analysis and decomposition analysis.
Main Results:
- Documented a suite of rural health disadvantages compared to urban areas.
- Observed that rural health disadvantages were often attenuated or insignificant after accounting for county-level characteristics.
- Decomposition analysis revealed county characteristics explain more variation in health measures than rural-urban status.
Conclusions:
- County-level factors play a substantial role in explaining rural health disparities.
- Findings can inform strategies to improve rural health and economic outcomes.
- Highlights the importance of integrating biomarker and place-based data for future research.
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