The Hidden Costs of Decline: Health Disparities in America's Diminishing Micropolitan Areas
September 2025
Working Paper Number:
CES-25-70
Abstract
This study examines the relationship between long-term population change and health outcomes in U.S. micropolitan areas, with a focus on life expectancy and mortality disparities. Using a county typology based on the historical population trajectories of micropolitan cores from 1940 to 2020, this analysis reveals that health outcomes are substantially worse in places that experienced sustained decline. These disparities persist even after controlling for demographic and socioeconomic characteristics, suggesting that population loss itself is a key driver of poor public health. Declining micropolitan areas are older, less educated, and report high rates of behavioral risk factors, including smoking, excessive drinking, and physical inactivity. By linking historical demographic trends to tract-level data, this analysis highlights the distinct challenges facing the urban cores of shrinking micropolitan areas. Population decline emerges not only as a demographic trend, but as a marker of structural disadvantage with measurable consequences for community health.
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metropolitan,
country,
rural,
disadvantaged,
population,
urban,
town,
urbanization,
city,
socioeconomic,
poverty,
health,
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disparity,
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American Community Survey,
National Center for Health Statistics,
Core Based Statistical Area,
Centers for Disease Control and Prevention,
Longitudinal Data Base,
Robert Wood Johnson Foundation
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