Multistate research shows health effects from chronic stress impact rural residents more than urban

A study led by a team of Pennsylvania State University researchers has shown that living rurally is associated with more “wear and tear” on the body’s system from exposure to chronic stress than for urban residents. The findings were published in the journal “SSM–Population Health.” 

Studies have long shown that rural populations in the United States have worse health outcomes than urban populations across measures that include self-rated health, chronic conditions, disability, physical activity, health behaviors, access to care and mortality. This study sought to improve our understanding of why these rural-urban health disparities exist. 

The researchers analyzed data on adults from the National Health and Nutrition Examination Survey, the only publicly available version of this dataset that contains information on rural versus urban residence. 

Allostatic load index is a measure of the biomarkers related to stress. The team looked at health biomarkers per person out of the 10 available that exceeded a clinically significant threshold, including blood pressure, pulse rate, total cholesterol, “good” cholesterol, body mass index, and measures to diagnose prediabetes or diabetes, kidney or liver problems, or chronic inflammatory disease such as rheumatoid arthritis. 

The data showed that rural residence is associated with allostatic load levels by all age groups except in the oldest age group (80 and over); allostatic load levels in urban residents “caught up” to rural residents among this age group. The rural disadvantages remained strong even when accounting for covariates, such as socioeconomic status. 

Rural-urban disparities in stress and allostatic load are mainly unaddressed and may reflect broader issues, such as economic inequality and unequal access to care. Rural-urban identifiers should be made more widely available in national public health datasets to increase our understanding of the factors affecting allostatic load disparities and to inform policy interventions.

View the full statement on the NIDB.

Project supported by Hatch Multistate funds and non-profit grants & contracts. Photo courtesy of the Pennsylvania Agricultural Experiment Station.