SAIMSARA Journal

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Urban–Rural Differences in Life Expectancy and Healthy Survival: Scoping Review with ☸️SAIMSARA.

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Longevity

Issue 2, Volume 1, 2026

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• Last update: 2026-03-27 22:34:32
What is this paper about
This paper shows that people in urban areas now usually live longer and spend more years in good health, but the gap is not fixed and seems to depend on cardiovascular risk, injuries, deprivation, and access to care. The full paper is worth reading because it shows where the urban advantage is strongest, where rural populations still do better, and which health system failures most likely drive the difference.
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DOI: 10.62487/saimsara70cf7c47

Abstract: To synthesize global evidence regarding the disparities in life expectancy, disability-free life expectancy (DFLE), and cause-specific mortality between urban and rural populations, identifying the primary drivers of these geographic health inequalities. The review utilises 115 original studies with 2392327 total participants (topic deduplicated ΣN). The evidence map indicates that a contemporary urban advantage in life expectancy and healthy survival is the dominant pattern, although its size and direction remain context dependent. Concrete anchors include a 2.3-year urban advantage in China in 2013 and a widening U.S. gap from 0.4 to 2.0 years between 1971 and 2009, while some settings such as Indonesia showed a rural advantage of 2.2 years for men and 1.2 years for women at age 30. Across the mapped literature, the most consistent signals point to cardiovascular disease, stroke, hypertension, injuries, and socioeconomic deprivation as major contributors to rural life expectancy deficits, with health-adjusted outcomes generally favoring urban populations as well. These findings support practical emphasis on strengthening rural prevention, emergency care, and chronic disease management, particularly for cardiovascular and injury-related conditions. At the same time, the heterogeneity across countries, age groups, sexes, and pandemic periods suggests that urban-rural gaps should be interpreted as socially and epidemiologically contingent rather than uniform. Future research should use harmonized definitions and longitudinal designs to disentangle rurality from deprivation and to clarify why some populations retain or regain a rural longevity advantage.

Keywords: Rural-urban health disparities; Life expectancy; Mortality differentials; Disability-free life expectancy; Health equity; Geographic health inequalities; Cause-specific mortality; Rural health disadvantage; Urban-rural continuum; Healthy life expectancy

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