Rural Counties Lost More Years of Life than Urban Counties in 2020

Yue Sun

Rural mortality rates have been higher than urban mortality rates for decades in the United States. Now, higher COVID-19 mortality rates in rural areas threaten to exacerbate the existing rural mortality penalty. Figure 1 shows average years of potential life lost (YPLL) due to all causes of death per 100,000 population by rural-urban continuum in 2019 and 2020. YPLL is the difference between 75 years old and the actual age of death. For example, someone who died at age 65 would have ten years of potential life lost. Figure 1 averages these lost life years across all counties within each category. Rural counties had higher average YPLL lost than urban counties in both 2019 and 2020. Compared to an average of 7,300 YPLL across large urban counties, the smallest most remote rural counties experienced an average of over 10,000 YPLL in 2020. Average YPLL also increased in nearly all categories between 2019 and 2020, but the increases were largest in the smallest rural counties and in large rural counties adjacent to metro areas. Given that COVID-19 contributed to more excess deaths than any other cause of death in 2020 (that is, more deaths than we observe in a typical year), we can likely attribute the increase in YPLL to the COVID-19 pandemic. In the short term, governments and businesses should take efforts to increase COVID-19 vaccination rates in rural counties. In the long term, federal, state, and local governments must target social, structural, and policy determinants of health and premature mortality that disproportionately affect rural residents.

Data Sources: USDA Economic Research Service Rural-Urban Continuum Codes; Health Data 2019-2020, provided by Social Explorer. Notes: N=2,843 counties. For details on how the RUCCs are defined, visit USDA ERS

About the Author – Yue Sun ( is a Ph.D. student in the Department of Sociology, a Lerner Graduate Fellow in the Lerner Center for Public Health Promotion, and an Affiliate of the Policy, Place, and Population Health Lab in the Maxwell School at Syracuse University.