LAUSR

All-cause mortality rates in rural areas have exceeded those in urban areas of the US since the 1980s, and the gap continues to widen. Yet no definitive causes of this difference are known, and within-state differences that might be amenable to state-level policy have not been explored. An analysis of 2016 state-level data indicated that rural mortality exceeded urban mortality in all but three states, with substantial variability in both rates across states. Overall, higher rural mortality at the state level can be mainly explained by three factors: socioeconomic deprivation, physician shortages, and lack of health insurance. To a certain degree, these factors reflect a state's health policies, such as expansion of eligibility for Medicaid, health infrastructure, and socioeconomic conditions. Our findings suggest that state and federal policy efforts to address rural-urban disparities in these areas could alleviate the higher rates of all-cause mortality faced by rural US residents.