EXHIBIT 3.

Change in age- and sex-standardized all-cause mortality among rural and urban dually enrolled Medicare beneficiaries, by census region, 2004 and 2017

	Rural			Urban
Region (states)	2004	2017	Relative percent change	2004	2017	Relative percent change
Overall	96.6	92.7	−4.0	86.9	72.8	−16.2
New England (CT, ME, MA, NH, RI, VT)	90.0	74.2	−17.6	81.4	66.3	−18.6
Mid-Atlantic (NJ, NY, PA)	90.5	79.7	−11.9	73.5	59.9	−18.5
East North Central (IL, IN, MI, OH, WI)	114.9	108.9	−5.2	109.6	92.0	−16.1
West North Central (IA, KS, MN, MO, NE, ND, SD)	100.4	103.9	+ 3.5	101.1	94.4	−6.6
South Atlantic (DE, FL, GA, MD, NC, SC, VA, DC, WV)	97.1	94.1	−3.1	99.0	81.8	−17.4
East South Central (AL, KY, MS, TN)	90.0	91.8	+ 2.0	97.5	92.1	−5.5
West South Central (AR, LA, OK, TX)	88.8	87.9	−1.0	83.6	71.7	−14.2
Mountain (AZ, CO, ID, MT, NV, NM, UT, WY)	98.1	88.4	−9.9	99.6	84.3	−15.4
Pacific (AK, CA, HI, OR, WA)	99.3	86.9	−12.5	73.4	59.7	−18.7

source Authors’analysis of dually enrolled Medicare (fee-for-service and Medicare Advantage) beneficiaries, 2004–17, using rural-urban commuting area codes and data from the Centers for Medicare and Medicaid Services Medicare Master Beneficiary Summary Files. note All p values were <0.001 for difference in rural versus urban change over time except for the Mid-Atlantic (p = 0.17), New England (p = 0.80), Pacific (p = 0.35), and Mountain (p = 0.007) regions.