The overall age-adjusted death rate in rural areas has been greater than that of urban areas over the last two decades (Garcia, 2017; Moy 2017). Alachua County reported the county experienced an age adjusted death rate of 764.8 deaths per 100,000 in 2018, about 80 more deaths than the Florida average of 679.4 deaths per 100,000 for the same year (Florida Department of Health, 2020). A confluence of predisposing and reinforcing psychological and socioeconomic risk factors at the individual, community, and public policy levels are responsible for the disparities in preventable deaths in rural areas (Garcia, 2017; Moy, 2017; Garcia, 2019). Among these, adverse childhood experiences (ACE’s) play an important role as they are strongly correlated with increasing mortality and adverse health behaviors (Felitti, et al., 1998). Additionally, individuals in rural areas are more likely to be older, current smokers, uninsured, and further from primary care clinics which contribute to increased risk for mortality and lower utilization of preventative and curative care (US DHHS 2014; Robinson & Willyard, 202; Skinner & Slifkin, 2007). Targeted, trauma informed interventions to rural areas that identify ACE’s, increase healthy behaviors, and improve access to care are needed to address ACE’s and their derivative adverse health effects including excess mortality.
Garcia, M. C., Faul, M., Massetti, G., Thomas, C. C., Hong, Y., Bauer, U. E., & Iademarco, M. F. (2017). Reducing Potentially Excess Deaths from the Five Leading Causes of Death in the Rural United States. Morbidity and Mortality Weekly Report. Surveillance Summaries (Washington, D.C. : 2002), 66(2), 1–7. https://doi.org/10.15585/mmwr.ss6602a1
Moy, E., Garcia, M. C., Bastian, B., Rossen, L. M., Ingram, D. D., Faul, M., Massetti, G. M., Thomas, C. C., Hong, Y., Yoon, P. W., & Iademarco, M. F. (2017). Leading Causes of Death in Nonmetropolitan and Metropolitan Areas- United States, 1999-2014. Morbidity and Mortality Weekly Report. Surveillance Summaries (Washington, D.C. : 2002), 66(1), 1–8. https://doi.org/10.15585/mmwr.ss6601a1
Garcia, M. C., Rossen, L. M., Bastian, B., Faul, M., Dowling, N. F., Thomas, C. C., Schieb, L., Hong, Y., Yoon, P. W., & Iademarco, M. F. (2019). Potentially Excess Deaths from the Five Leading Causes of Death in Metropolitan and Nonmetropolitan Counties - United States, 2010-2017. Morbidity and Mortality Weekly Report. Surveillance Summaries (Washington, D.C. : 2002), 68(10), 1–11. https://doi.org/10.15585/mmwr.ss6810a1
Florida Department of Health. (2022, October 19). Alachua County. Alachua County Community Health Assessment. Retrieved March 22, 2023, from https://www.floridahealth.gov/...%20county/index.html
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/s0749-3797(98)00017-8
US Department of Health and Human Services. The health consequences of smoking: 50 years of progress. A report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, CDC; 2014.
Robinson, S., & Willyard, K. A. (2021, June 8). Small Area Health Insurance Estimates: 2019. Census.gov. Retrieved April 12, 2023, from https://www.census.gov/library...021/demo/p30-09.html
Skinner, A. C., & Slifkin, R. T. (2007). Rural/urban differences in barriers to and burden of care for children with special health care needs. The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, 23(2), 150–157. https://doi.org/10.1111/j.1748-0361.2007.00082.x
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