Assessment of Urban-Rural Differences in Schizophrenia Mortality in the United States Using the CDC-WONDER Database: A Retrospective Study

Schizophrenia has been linked to a decrease in lifespan. Urban-rural disparity provides a snapshot of health risks within two separate populations and helps assess the population risks involved in schizophrenia mortality. This retrospective study aimed to assess disparities in mortality rates due to schizophrenia between urban and rural populations. Methodology: This retrospective study analyzed schizophrenia-related mortality data (ICD-10 code F20) from 1999 to 2020, extracted from the CDC-WONDER Online Database on March 20, 2024. The data were stratified using the 2013 urbanization classification into urban and rural regions, and further categorized by age, sex, race, and census region. As a publicly available, de-identified dataset, it required no ethics approval. Statistical analysis was conducted using R (2023; R Foundation for Statistical Computing, Vienna, Austria), and visualizations were generated using GGPlot2. A total of 9,359 schizophrenia-related deaths were identified from 1999 to 2020 using the CDC-WONDER database. The absolute number of deaths was higher in urban areas (7,253) compared to rural areas (2,106). However, when adjusted for population, the crude mortality rate was significantly higher in rural areas across most demographic groups. This rural-urban disparity in the crude mortality rate was statistically significant for individuals aged 45 years and above, both sexes, and among the White and Black or African American populations (p < 0.001). Crude mortality rates in rural areas showed consistent elevation over time, despite fluctuations, and were notably higher in elderly age groups, particularly those aged 65-85+ years. This retrospective study highlights significant differences in rural versus urban crude mortality rates in patients with schizophrenia and highlights the need to address disparities in healthcare for schizophrenia patients.