Changes in Age-Adjusted Mortality Rates and Disparities for Rural Physician Shortage Areas Staffed by the National Health Service Corps: 1984–1998


  • At the time of this study, George Fryer and Larry Green were at the Robert Graham Center for Policy Studies in Family Practice and Primary Care, Washington, DC. The views and conclusions of this paper are solely those of the authors. The information and opinions contained in research from the Robert Graham Center do not necessarily reflect the views or policy of the American Academy of Family Physicians.

For further information, contact: Donald Pathman, MD, MPH, Cecil G. Sheps Center, UNC CB# 7590, 725 N. Airport Road, Chapel Hill, NC 27599; e-mail


ABSTRACT: Objective: This study assesses whether the National Health Service Corps's legislated goals to see health improve and health disparities lessen are being met in rural health professional shortage areas for a key population health indicator: age-adjusted mortality. Methods: In a descriptive study using a pre-post design with comparison groups, the authors calculated age-adjusted mortality rates at baseline (1981-1983) and follow-up (1996-1998) for the populations of 448 rural whole-county health professional shortage areas arrayed into 3 groups based on the number of study years they were staffed by National Health Service Corps physicians, physician assistants, and nurse practitioners (terms of 1 to 7, 8 to 11, and 12 to 15 years). The authors compared changes over time in age-adjusted mortality rates in the 3 county groups that had National Health Service Corps staffing with rate changes in 172 whole-county rural health professional shortage areas and 772 non–health professional shortage area rural counties that had no National Health Service Corps. Results: At baseline, age-adjusted mortality was higher in all 4 health professional shortage area county groups than in the non–health professional shortage area county group. Age-adjusted mortality rates improved with time in all groups, including health professional shortage area counties both with and without National Health Service Corps support, and non–health professional shortage area counties. Essentially, baseline differences in age-adjusted mortality rates between health professional shortage areas and non–health professional shortage area counties did not diminish with time, whether or not there was National Health Service Corps support. Conclusions: From the early 1980s through the mid-1990s, the National Health Service Corps's goal to see health improve in rural health professional shortage areas was met, but its goal to diminish geographical health disparities was not. Because age-adjusted mortality rates improved in all county groups, the authors conclude that improvement was likely due to a variety of factors, including decreasing poverty and unemployment rates and increasing primary care physician-to-population ratios, to which the National Health Service Corps may have contributed.