摘要：The nonmetropolitan mortality penalty results in an estimated 40 201 excessive US deaths per year, deaths that would not occur if nonmetropolitan and metropolitan residents died at the same rate. We explored the underlying causes of the nonmetropolitan mortality penalty by examining variation in cause of death. Declines in heart disease and cancer death rates in metropolitan areas drive the nonmetropolitan mortality penalty. Future work should explore why the top causes of death are higher in nonmetropolitan areas than they are in metropolitan areas. Persistent spatial clusters of metropolitan and nonmetropolitan differences in mortality 1 and in life expectancy 2 exist in the United States and in European countries. 3 Research indicates that the historical metropolitan mortality penalty—higher rates of death in cities than in rural areas—has been reversed since the mid 1980s. Now, nonmetropolitan areas have higher all-cause mortality rates than do metropolitan areas. 4 We explored cause-specific mortality rates in the United States from the last 40 years and determined that the relatively recent nonmetropolitan mortality penalty is largely a result of changes in place-specific rates of death from heart disease and cancer, although there have been no changes in the ratio of metropolitan-to-nonmetropolitan mortality rates associated with strokes.
