Urban-rural differences in excess mortality among high-poverty populations: evidence from the Harlem Household Survey and the Pitt County, North Carolina Study of African American Health.
Black youth residing in high-poverty areas have dramatically lower probabilities of surviving to age 65 if they are urban than if they are rural. Chronic disease deaths contribute heavily. We begin to probe the reasons using the Harlem Household Survey (HHS) and the Pitt County, North Carolina Study of African American Health (PCS). We compare HHS and PCS respondents on chronic disease rates, health behaviors, social support, employment, indicators of health care access, and health insurance. Chronic disease profiles do not favor Pitt County. Smoking uptake is similar across samples, but PCS respondents are more likely to quit. Indicators of access to health care and private health insurance are more favorable in Pitt County. Findings suggest rural mortality is averted through secondary or tertiary prevention, not primary. Macroeconomic and health system changes of the past 20 years may have left poor urban Blacks as medically underserved as poor rural Blacks.
Geronimus
Arline T
AT
Department of Health Behavior and Health Education, School of Public Health, University of Michigan, USA. arline@umich.edu
Colen
Cynthia G
CG
Shochet
Tara
T
Ingber
Lori Barer
LB
James
Sherman A
SA
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D002908:Chronic Disease / Q000453:epidemiology; D004651:Employment; D005260:Female; D015438:Health Behavior; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D009657:North Carolina / Q000453:epidemiology; D011203:Poverty / Q000208:ethnology / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data*; D012907:Smoking; D012944:Social Support; D014505:Urban Population / Q000706:statistics & numerical data*