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Pollution Sources and Mortality Rates Across Rural-Urban Areas in the United States


  • The authors gratefully acknowledge the assistance of the following persons in the development of this study: Melissa Ahern, Hilda Heady, Juhua Luo, Jay Mason, Cynthia Persily, Sally Richardson, Clifton Strange, and Laura Wright. Support for this report was provided by the Office of Rural Health Policy, Health Resources and Services Administration, PHS Grant No. 1 U1CRH10664-01-00. For further information, contact: Michael Hendryx, PhD, Department of Community Medicine, West Virginia University, PO Box 9190, Morgantown, WV 26506; e-mail


Purpose: To conduct an assessment of rural environmental pollution sources and associated population mortality rates.

Methods: The design is a secondary analysis of county-level data from the Environmental Protection Agency (EPA), Department of Agriculture, National Land Cover Dataset, Energy Information Administration, Centers for Disease Control and Prevention, the US Census, and others. We described the types of pollution sources present in metropolitan and nonmetropolitan counties and examined the associations between these sources and rates of all-cause, cardiovascular, respiratory, and cancer mortality while controlling for age, race, and other covariates.

Findings: Rural counties had 65,055 EPA-monitored pollution discharge sites. As expected, rural counties had significantly greater exposure to potential agriculture-related pollution. Regression models specific to rural counties indicated that greater density of water pollution sources was significantly associated with greater total and cancer mortality. Rural air pollution sources were associated with greater cancer mortality rates. Rural coal mining areas had higher total, cancer, and respiratory disease mortality rates. Agricultural production was generally associated with lower mortality rates. Greater levels of human development were significantly related to higher adjusted total and cancer mortality.

Conclusions: The association between pollution sources and mortality risk is not a phenomenon limited to metropolitan areas. Results carry policy implications regarding the need for effective environmental standards and monitoring. Further research is needed to better understand the types and distributions of pollution in rural areas, and the health consequences that result.