Exploring Rurality and Racial/Ethnic Disparities in Texas Mortality: A Scoping Review of the Five Leading Causes of Death

OBJECTIVE: While the five leading causes of death in Texas mirror national trends, the unique racial/ethnic and geographical diversity of the state requires a focused analysis of mortality disparities. To address this gap, we conducted a scoping review of Texas-specific peer-reviewed studies on how race/ethnicity and rurality impact mortality from heart disease, cancer, unintentional injuries, stroke, and chronic lower respiratory diseases (CLRDs). METHODS: Using a scoping review methodology, we identified Texas-specific empirical articles examining the relationship between either rurality or race/ethnicity and the leading causes of death. We extracted and analyzed data from the included studies using a coding instrument specifically designed for this study. Descriptive synthesis summarized study trends, and multivariable logistic regression assessed overarching patterns. RESULTS: Our synthesis of the Texas-specific literature reveals that cancer was the focus of nearly half of the studies (49.4%), whereas rurality was seldom examined (4.2%). Multivariable logistic regression showed that studies on CLRDs were more likely to find higher mortality among Blacks (OR = 3.07) and Hispanics (OR = 4.24). For stroke, Hispanics were associated with increased mortality (OR = 2.49), while for unintentional injuries, the study found significantly higher mortality for Native Americans (OR = 8.72) and Blacks (OR = 2.76). CONCLUSIONS: Existing Texas-focused studies consistently link racial and ethnic minority status with higher mortality from the five leading causes of death. However, significant gaps remain, particularly concerning the intersection of race/ethnicity and rurality. Future Texas-based research should prioritize these intersectional factors to better understand and address persistent mortality disparities.