摘要：We discovered an emerging non-metropolitan mortality penalty by contrasting 37 years of age-adjusted mortality rates for metropolitan versus nonmetropolitan US counties. During the 1980s, annual metropolitan–nonmetropolitan differences averaged 6.2 excess deaths per 100000 nonmetropolitan population, or approximately 3600 excess deaths; however, by 2000 to 2004, the difference had increased more than 10 times to average 71.7 excess deaths, or approximately 35 000 excess deaths. We recommend that research be undertaken to evaluate and utilize our preliminary findings of an emerging US nonmetropolitan mortality penalty. The dominant trend in recent US mortality has been one of decreasing death rates. However, population subgroups and geographic regions have differing mortality experiences. Early in US history, there was a substantially higher mortality rate in the cities often referred to as the urban “mortality penalty.” The spread of contagious diseases in densely populated sites, poor water quality, and inadequate sewage and garbage disposal explained the urban or metropolitan penalty. 1 By 1940, improvements in public health, a growing public service infrastructure, and advances in health-care had eliminated the metropolitan penalty. 1 Metropolitan–nonmetropolitan mortality rates had become similar. The metropolitan–nonmetropolitan distinction, however, continues to be a fundamental framework in health discussions of residential aspects of public health policy, and of access to and disparities in health-care. 2 – 5 Once metropolitan–nonmetropolitan mortality rates became similar, the focus of mortality research shifted to subnational regions and neighborhoods (e.g., the mortality disadvantages of the inner city or of the nonmetropolitan poor). 6 – 7 In our study, we revisited national trends in mortality by examining 37 years of metropolitan–nonmetropolitan mortality patterns as part of a larger study investigating healthful and unhealthful places in the United States. We had anticipated demonstrating the advantages of using other spatial definitions as being more valuable in identifying geographic disparities in health outcomes. Instead, we found a recent emerging pattern of nonmetropolitan mortality disparities.
