'Excess' Mortality Higher for Blacks in Urban Versus Rural Areas

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Harlem in New York City and Pitt County, N.C., are both poor parts of the country, but the African-American male population of Pitt County has half the excess mortality rate of Harlem. The difference may be that Harlem residents have less access to good health care and less social support than do the rural inhabitants of Pitt County, a new study suggests.

"I did not expect these results. If you told me earlier that rural people would have had better health care, I would not have believed it," said lead study author Dr. Arline Geronimus.

"Excess mortality" is the number of deaths per 100,000 African-Americans over and above the death rate for whites nationwide.

The study, published in the August issue of the Journal of Health Care for the Poor and Underserved, evaluated data from separate surveys on risk factors associated with excess mortality. Responses came from 963 African-American adults in Harlem and 1,773 of their Pitt County peers.

At the time of the surveys, Pitt County had a poverty rate of 36 percent compared with a poverty rate of 43 percent in Harlem. Nationally, the poverty rate among whites is 7 percent.

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In 1990, there were 504 excess deaths for African-American men and 224 for women in Pitt County. Excess deaths among African-Americans in Harlem reached 1,296 for men and 534 for women. Yet, health conditions such as hypertension and obesity, which lead to excess mortality, were more common in Pitt County than Harlem.

The most likely reason for the difference appears to be access to health care, with 84 percent of Pitt County respondents and 73 percent of Harlem respondents reporting they had a usual source of health care. The only health behavior that could explain some of the difference in mortality was that Harlem residents were more likely to smoke.

Most previous studies have pointed to a deficiency in care in rural areas, said Geronimus, a professor at the School of Public Health and Research, University of Michigan.

Social connections also appear to play a role. Pitt County residents reported having more social connection; 74 percent said they usually had someone to talk to about personal matters compared with 41 percent of Harlem residents. This may mean that public policies should promote social connections and avoid undermining them, Geronimus said.

"The findings reinforce those of other studies, which suggest that a multipronged approach is needed to eliminate health disparities," said Brian Smedley, Ph.D., research director of the Opportunity Agenda, a communications research and policy organization in Washington.

Public policy should reinforce factors such as neighborhood and community characteristics that influence health across a range of disease areas, Smedley said. Mortality disparities should be addressed by policies that promote safer, more equitable communities and living arrangements, he added.

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