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Arnold School of Public Health

Study reveals pediatric mortality rates declining more slowly for rural children compared to urban peers

February 3, 2020 | Erin Bluvas,

Recent research led by Health Services Policy and Management Distinguished Professor Emerita Janice Probst has found that the decline of deaths among children living in the rural United States has lagged behind rates of decline for urban children, particularly among non-Hispanic black infants and Indian/Alaska Native children. Probst’s research team, which includes Rural and Minority Health Research Center research assistant professor Whitney Zahnd and former post-doctoral fellow Charity Breneman, published the findings from their study in Health Affairs.

Pediatric mortality rates in the United States have steadily declined over the past two decades, although they remain higher than those found in Canada, the United Kingdom and most other developed countries. Previous research has shown, however, that progress has not been even across racial/ethnic groups – with mortality rates remaining higher among non-Hispanic black and American Indian/Alaska Native children compared to non-Hispanic white children. The investigators wondered if rural children had also failed to benefit from overall improvements in children’s health.

In their study, the researchers used mortality data from the Centers for Disease Control and Prevention to examine how the mortality rates of children living in rural counties compared to those in urban communities during the period of 1999 – 2017. They found that rural children experienced higher mortality rates than their urban peers across all age groups, with non-Hispanic black infants and American Indian/Alaska Native children particularly at risk.

Across the 18-year period, the death rate among rural children dropped by 19 percent while the death rate among urban children dropped by 24 percent, increasing rural disparities. Among infants, for example, the researchers found a rural disadvantage of 7 percent in 1999 that grew to 18 percent in 2017.

“Reducing mortality among infants, children and young adults is a Healthy People 2020 objective, and some research suggests that many targets have been met,” Probst says. “However, our study indicates that this decline has not been equitable, as disparities exist across racial/ethnic groups and geography.”

The authors point to several factors that influence higher mortality rates of infants and children in rural areas. As a leading cause of death among children everywhere, motor vehicle crashes are more likely to be fatal in rural counties due to higher driving speeds, lower-quality road designs, and greater distances to trauma centers. Persistently lower physician-to-population ratios in rural areas, which lead to higher rates of hospitalization and ambulatory care, are also underlying factors. Finally, recent changes in health care infrastructure in rural American (e.g., hospital closures, maternity unit closures, declining workforce) play a role as well.

“We need to take steps to reduce the disproportionate number of rural children’s lives lost,” Probst says. “Our team has identified public health activities that will be critical to this effort: addressing the burdens of unintentional injury and suicide among rural youth and surveilling health outcomes among rural children in racial/ethnic minority groups to address ongoing disparities. Both research and advocacy are needed to bring the health of rural children to the forefront among national goals and objectives.”


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