What’s driving infant mortality rates in rural areas? Hint: It’s more than access to health care

| Academic & Student Affairs, COPH Home Page Feed, COPH Office of Research, Featured News, Monday Letter, Offices, Our Research

Rural counties have the highest infant mortality rates across the United States when compared with rates in more urban counties—but why?

New research conducted by the USF College of Public Health’s (COPH) Dr. Russell Kirby, along with colleagues Deborah Ehrenthal and Daphne Kuo, points to a complicated picture. 

The article, Infant Mortality in Rural and Nonrural Counties in the United States, was published in November in the journal Pediatrics.

Kirby, a perinatal and pediatric epidemiologist, and his colleagues looked at infant deaths recorded in the US from 2014-2016 (infant death was defined as deaths occurring to live births within the first year of life) and then classified the deaths by whether they occurred in rural or nonrural counties using National Center for Health Statistics Urban-Rural Classification Scheme. They found that infant deaths increased as counties became more rural, but that lack of available health care wasn’t the main factor driving these deaths.

Shutterstock image

“Higher infant mortality rates in rural counties are best explained by their greater socioeconomic disadvantage than more-limited access to health care or the greater prevalence of a mother’s individual health risks,” wrote the authors.

According to Kirby, a USF Distinguished Professor and Marrell Endowed Chair, many of these rural infant deaths resulted from non-perinatal causes, such as sudden unexpected death in infancy (including SIDS), co-sleeping, and intentional and unintentional injury. “Health promotion and education messaging for rural communities should be increased, along with the use of home visiting, which can also be provided via virtual modalities,” he stated.

Kirby also acknowledged that lowering infant mortality rates in rural communities will take a meeting of many minds.

“This will take considerable effort, not only from public health and health care providers, but also from community-based organizations, local nonprofits and advocates,” he said.  “Much of this occurs beneath the radar—rural communities have smaller populations and don’t qualify for federal programs such as Healthy Start and may not have sufficient population for federally qualified health centers. Future work will examine how disparities by race-ethnicity play out by rurality, and how nativity (maternal birth in the US or another country) affects the patterns.”

Story by Donna Campisano, USF College of Public Health