'Massive disparities' in mortality rates of urban, rural counties from drugs, mental illness

A new study finds that while some parts of America are seeing improvements in their mortality rates, rural areas and counties with Native American reservations are seeing declines from substance abuse and mental health issues.

The stark difference between the various regions of the US has been in the spotlight as cultural differences were largely the focus of interest. However, a study from the Institute for Health Metrics and Evaluation (IHME) shows that the differences between more metropolitan parts of the US and rural or disenfranchised areas is literally a matter of life and death.

While the mortality rates in urban areas generally declined from 1980 to 2014, counties in the central US had less improvement compared to counties in rural parts of the west, northern Midwest, New England and southern Florida.

The study looked at deaths in 21 different cause groups ranging from cancer to diarrhea to infectious diseases, and it found that while some causes of death, such as mortalities that result from transport injuries, have mostly declined since 1980, others have skyrocketed. Deaths from mental and substance use disorders have generally increased across the country and account for the eighth most years of life lost in the country.

The effects have not been equally felt nationwide. Clusters of counties in eastern Kentucky and southwest West Virginia saw particularly high increases, while Alaska, North Dakota, South Dakota and counties with Native American reservations in the southwest all saw a 188 percent increase of deaths from mental and substance abuse disorders.

Some counties in Kentucky, West Virginia, Ohio, Indiana, western Pennsylvania and east-central Missouri actually saw their mortality rates increase by at least 1,000 percent from mental and substance abuse disorders.

But during the same time period that mortality rates spiked in these rural areas, the mortality rate in Manhattan dropped by 72 percent.

"While the leading causes of death are similar across counties, we found massive disparities in the rates at which people are dying among causes and communities," lead author Laura Dwyer-Lindgren said in a statement.

The regional differences are even starker when looking at cirrhosis and chronic liver diseases. In the areas around New York City, such as Long Island, North New Jersey, southwestern Connecticut and other southern New York counties saw rates of death from chronic liver dramatically decrease from 78 to 47 percent. However, areas in western Oregon and western Texas saw high increases of 89 percent to 210 percent.

On a more positive note, the rate of cirrhosis and chronic liver diseases actually decreased in parts of Alaska – particularly in the North Slope region of Alaska that is predominantly Native American. While the study does not offer a reason for the improvement, many of the communities in that area have banned the sale, importation and possession of alcohol. 

Self-harm and interpersonal violence has also been an increasingly large problem and represented the eighth leading cause of death in 2014. Regions with reservations in North and South Dakota were home to the highest rates along with states in the Southwest. Violence has been a problem for Native American communities, where a National Institute of Justice (NIJ) study found that more than four-in-five American Indian and Alaska Native women and men experienced violence in their lifetimes.

Self-harm decreased in the US by 22.1 percent between 1980 and 2014, but exploded in areas along the Canadian border in North Dakota and Michigan, along with parts of the Midwest and New England. The number of self-harm and interpersonal violence related deaths may be declining in total, but 51.2 percent of counties have seen increases.

Many were shocked when the life expectancy in the US decreased for the first time in decades. The causes behind the fall in life expectancy are complicated, as the study from the IHME paints a portrait of what is killing Americans and where.