By Carolyn Crist

(Reuters Health) – Although mortality rates among U.S. infants, children and teens have declined overall in the last two decades, rural kids still face higher odds of death than urban kids, researchers say.

Accidents and suicide are the leading causes of child deaths in rural areas, and both are greater risks for rural than for urban kids, researchers report in a special issue of Health Affairs devoted to health in the rural U.S.

“As a society, there is no such thing as ‘other people’s kids’ – we have to be attentive to the health of all our children,” said study leader Janice Probst of the University of South Carolina, in Columbia.

“Continuing to examine health outcomes and death – which is the final and most distressing one – lets us know how we are doing. Are we making things better?” she told Reuters Health by email. “Short answer, yes . . . however, we haven’t made a dent in rural disparities.”

Probst and colleagues analyzed mortality data from the Centers for Disease Control and Prevention (CDC) to see whether children in rural areas up to age 19 benefited from the same declines in death rates during 1999-2017 that the nation saw as a whole. The 1,976 rural counties examined accounted for about 15% of the U.S. population.

Across all age groups, the death rate for rural children dropped by 19% over the two decades, from 77.6 per 100,000 in 1999 to 62.9 in 2017. But that compares with a 24% drop for urban children, from 66.4 to 50.2 per 100,000.

As a result, the gap in mortality rates between urban and rural children widened, from 17% in 1999 to 25% in 2017.

In rural areas, non-Hispanic black infants under age 1 and American Indian/Alaska Native children ages 1 through 19 were at especially high risk, while Asian/Pacific Islander children had the lowest death rates across all ages, followed by Hispanic children.

The data revealed several interesting patterns, the researchers note. For instance, sometimes living in rural areas was beneficial, in that rural youth were less likely than urban counterparts to die from assault. This was particularly true for black youth between ages 15 and 19.

At the same time, rural children ages 10 to 19 were more likely to die by suicide, probably due to greater availability of firearms and a lack of mental health services, Probst said.

In addition, death rates due to motor vehicle crashes, a leading cause of death among all children, were twice as high in rural areas, likely because of higher driving speeds and lower access to trauma hospitals, she noted.

Most surprising, however, was that the death rate among rural American Indian and Alaska Native children ages 15-19 was typically about double the rates in the group with the next-highest rates. Probst called this finding “a national disgrace.”

Future studies should investigate the effects of social determinants of health, such as education, income, race and poverty, on the rural gap, the study team concludes.

“Even the most ‘favorable’ regions exhibit higher black mortality rates than the most ‘unfavorable’ regions for white mortality rates,” noted Wesley James of Memphis University, in Tennesee, who was not involved in the study.

“The black population in rural America is often overlooked, but particularly in the South where there are substantial concentrations of African Americans, the mortality rates are alarmingly high,” James told Reuters Health by email.

Probst and colleagues also plan to analyze the national CDC data on a local level to understand factors that may increase or decrease mortality. Legislation around health insurance coverage of mental health services, for instance, could help with suicide rates, Probst said.

“Place makes a difference . . . and rural areas are locations that need special attention,” said Arthur Cosby of Mississippi State University, in Starkville, who also wasn’t involved in the study.

“Youth suicide rates are increasing for both rural and urban areas,” he told Reuters Health by email. “Our understanding of the causes for increasing suicide rates is insufficient and in need of additional research.”

SOURCE: Health Affairs, online November 20, 2019.