Geographic health disparities are well recognized in public health and health care delivery. The health of people in rural areas in particular is a recognized concern in the US and globally.¹^-3 In the US, the death rate is higher for rural vs urban areas (831 per 100 000 vs 704 per 100 000).⁴ Rural residents in the US have higher rates of chronic diseases⁵^,6 (diabetes, obesity, chronic obstructive pulmonary disease), stroke,⁵^,6 unintentional injury,⁵^,6 tobacco use,⁷ opioid overdose,⁸ cancers associated with modifiable risks,⁹ suicide,¹⁰ worse maternal health,¹¹ decreased confidence in the health care system,¹² and limited access to care.¹³^-17 In 2019, mortality rates were higher for the 10 leading causes of death in rural areas.¹⁸ Geographic health disparities also occur in other high-income countries, with evidence of overall worse rural health in Australia¹⁹ and Canada.²⁰^-22 In France and the Netherlands, there is evidence of worse perinatal health outcomes for women who live farther from hospitals, indicating that living in a rural area is a risk factor.²³

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