Although improvements in socioeconomic conditions and medical and technologic advancements contribute to reduced mortality rates over the past century, health disparities across various dimensions (e.g., race/ethnicity, gender, geographic location, and age) are becoming larger than ever in the U.S. As discussed in a paper in the February 2023 issue of the American Journal of Preventive Medicine, recent studies indicate increasing geographic inequalities in life expectancy. Regional variation in health outcomes is explained by differences in community-level factors, such as residential location, access to health care, access to healthy food, and proportion of college graduates. Health disparities can arise or be exacerbated when there is unequal access to these opportunities or resources. A dramatic increase in mortality occurs because of drug overdoses, suicide, and alcohol poisoning, referred to as deaths of despair or stress-related conditions (SRCs). A rise in SRC (2000-2015) first was reported among the non-Hispanic (NH) middle-aged White population in rural areas across the U.S.
Midlife death rates also rose significantly between 1999 and 2016 among people of color that was driven primarily by drug, alcohol, and suicide deaths, but also because of increases in dozens of organ ailments, such as hypertensive heart disease and liver cancer. In general, rural areas are likely to have fewer socioeconomic resources than urban areas because of their physical location and lack of material and human resources. Separation from others who may provide social support also could exacerbate mental health problems and thus increase the risk of drug, alcohol, and suicide mortality. A study described in the aforementioned paper indicates that SRC mortality rates from 2004 to 2016 were not distributed randomly across the contiguous counties in the U.S. Findings suggest that educational attainment, disability status, access to health care, and contextual conditions can serve as measures to develop more effective prevention and intervention programs to target specific localities and tackle the deaths of despair epidemic.