Theses and Dissertations

Issuing Body

Mississippi State University

Advisor

Brown, Dustin C.

Committee Member

Cosby, Arthur G.

Committee Member

Leap, Braden T.

Committee Member

Ralston, Margaret L.

Date of Degree

12-10-2021

Document Type

Dissertation - Open Access

Major

Sociology

Degree Name

Doctor of Philosophy (Ph.D)

College

College of Arts and Sciences

Department

Department of Sociology

Abstract

Since the mid-1980s, mortality rate improvements in urban areas have outpaced those in rural areas, leading to substantial urban-rural disparities in mortality. Research on urban-rural mortality disparities has focused exclusively on differences in mortality between urban and rural areas and has not examined differences in the amount of inequality in the length of life within these areas. Lifespan variation is an important dimension of health inequality that complements traditional metrics of mortality (i.e., mortality rates and life expectancy) by indicating the amount of inequality of lifespans within a population. This dissertation provides several contributions to our understanding of urban-rural differences in lifespan variation through three interrelated studies. First, I document trends in life expectancy and lifespan variation from 1990 to 2017 and show that nonmetropolitan populations have had smaller declines in lifespan variation than metropolitan populations. The urban-rural disparity in lifespan variation is mostly due to greater improvements in mortality in metropolitan areas but recent mortality increases among nonmetropolitan working-age adults have also contributed. Next, I investigate the extent of the rural mortality penalty among White and Black populations, an underexamined area in the rural mortality literature. Generally, I find that Black Americans living in rural places face an additional penalty; their lifespans are not only shorter but more variable. For Whites, improvements in large central metros are driving the urban-rural disparity. For Blacks, lower mortality rates in large suburbs are driving the disparity. This study underscores the importance of including Black Americans in studies of rural mortality. Finally, I show that most of the difference in lifespan variation between metro and nonmetro populations is due to preventable mortality among working-age adults (ages 25-64). Analyses of age and cause-specific mortality rates among working-age adults show that the largest disparities in preventable mortality are due to suicide and motor vehicle accidents in younger adults and heart disease and cancer in middle-aged adults. The results of these studies show that people living in rural places face an additional penalty; their lives are not only shorter, but the timing of death is more variable and uncertain.

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