According to a study, the gap in life expectancy between rural and urban areas can be up to 1.4 years in France. A figure which is explained in particular by the difficulties of access to care in certain departments.
The gaps in life expectancy between rural and urban areas have been widening for 30 years despite a positive Covid effect, which is equivalent to 14,216 additional annual deaths in rural areas, according to a study published Friday and commissioned by the Association of Rural Mayors of France (AMRF).
This study entrusted to the geographer Emmanuel Vigneron is an “update” of a previous one, released in 2020, which had revealed a difference in life expectancy of up to 2.2 years among men living in very rural areas compared to compared to those in the center of large cities.
Life expectancy has improved twice as fast in the city
In the last two years marked by the pandemic, the gap has narrowed to 1.4 years between 1990 and 2021 for men, and to 0.8 for women, compared to 2.2 and 0.9 between 1990 and 2019. In fact, many studies “have shown that Covid-19 has been more lethal in dense environments”.
But these differences “remain marked between rural departments and urban departments”, underlines the study, which judges the recent improvement “more cyclical than structural”.
While rural and urban “were equal in 1990, the situation observed in the rural departments in 2022 is comparable to that measured before 2010 in urban areas: i.e. a delay of 15 years”.
Which means that over the past 30 years, life expectancy “has improved twice as fast in the city as in the countryside”.
14,000 more dead in rural areas
According to a map of the comparative mortality index (ICM) at the scale of the 1666 living areas, the main mortality risk factor in France remains the regional geography, the North registering a risk much higher than the national average.
But on the scale of the same department, this ICM can vary completely depending on whether you are in the central city, generally a prefecture, which concentrates health services, or in a very rural area. Thus in Puy-de-Dôme, the ICM, from 91 to Clermont-Ferrand, continues to increase as one moves away from the city.
In total, these are “14,216 more deaths per year in rural areas than would be expected if life expectancy there were identical to that of cities”.
Chronic patients less well followed
It is in particular the difficulties encountered in accessing care that can explain these differences.
“The chronically ill will be less well followed in rural areas because there will be difficulties in accessing a treating doctor, (…) there are also fewer physiotherapists, fewer nurses, (. ..) the state of health of part of the population will worsen faster than if it were well monitored in a denser area”, explains Jean-Pierre Thierry health consultant for BFMTV.
Same observation for Isabelle Dugelet, mayor of La Gresle (Loire), who also points out the deadlines for accessing emergency services.
“We know that in the event of a heart attack there is a delay of half an hour for care in order to be able to survive, (…) but sometimes this delay is too short to reach the emergency room”, laments she on BFMTV, denouncing a “destruction of the health service which has existed for a very long time.
Areas of excess mortality
The study also reveals “edge effects” with areas of excess mortality located “at the limits of the departments and very often at the margins of the regions straddling two or three departments”, areas qualified as “abandoned”.
The AMRF, which regularly warns of medical deserts, makes several proposals, such as facilitating the installation of health professionals with a view to their better geographical distribution.
