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This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: AJPH.2007.123778v1 98/8/1470    most recent Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Cosby, A. G. Articles by Farrigan, T. Search for Related Content PubMed PubMed Citation Articles by Cosby, A. G. Articles by Farrigan, T. Related Collections Epidemiology Geography Social Science Rural Health Mortality Urban Health

Arthur G. Cosby, PhD, Tonya T. Neaves, MPPA, Ronald E. Cossman, PhD, Jeralynn S. Cossman, PhD, Wesley L. James, MS, Neal Feierabend, BA, David M. Mirvis, MD, Carol A. Jones, PhD and Tracey Farrigan, PhD

Arthur G. Cosby, Tonya T. Neaves, Ronald E. Cossman, Jeralynn S. Cossman, Wesley L. James, and Neal Feierabend are with the Social Science Research Center, Mississippi State University, Mississippi State. David M. Mirvis is with the University of Tennessee Health Science Center, Memphis. Carol A. Jones and Tracey Farrigan are with the Economic Research Service, US Department of Agriculture, Washington, DC.

Correspondence: Requests for reprint should be sent to Arthur G. Cosby, PhD, Giles Distinguished Professor and Director, Social Science Research Center, Mississippi State University, P.O. Box 5287, Mississippi State, MS 39762 (e-mail: arthur. cosby{at}ssrc.msstate.edu).

We discovered an emerging non-metropolitan mortality penalty by contrasting 37 years of age-adjusted mortality rates for metropolitan versus nonmetropolitan US counties. During the 1980s, annual metropolitan–nonmetropolitan differences averaged 6.2 excess deaths per 100000 nonmetropolitan population, or approximately 3600 excess deaths; however, by 2000 to 2004, the difference had increased more than 10 times to average 71.7 excess deaths, or approximately 35 000 excess deaths. We recommend that research be undertaken to evaluate and utilize our preliminary findings of an emerging US nonmetropolitan mortality penalty.