Health disparities in rural areas: The interaction of race, socioeconomic status, and geography

The elimination of health disparities is one of the overarching goals of Healthy People 2010. Race as a risk factor for health disparities can be particularly evident when comparing health indicators in metropolitan areas, where there are large populations of whites, African-Americans, and other races and ethnicities. For rural areas, however, where the percentage of minority populations is very low, does race remain a measurable risk factor for health disparities, or are other drivers – such as SES – more predominant?

The purpose of this study is to examine the potential influence of race vs. SES in rural areas with a low proportion of African-Americans. Race-specific mortality data were examined for the leading causes of death, including infant mortality, for 15 rural counties in East Tennessee, where African-Americans comprise 2.1% of the population, and 1 metropolitan county, where African-Americans comprise 8.6% of the population. For the metropolitan county, 45% of African-American infant deaths would have been averted had these infants died at the same rate as white infants. For the rural counties, 29% of African-American infant deaths would have been averted had these infants died at the same rate as white infants. When counties were grouped into quartiles according to county-level poverty data, 11% of infant deaths in lower SES counties would have been averted had infants in those counties died at the same rate as infants in higher SES counties. Both race and SES remain as risk factors for health disparities in rural areas, despite the low proportion of minorities.