Table 4.

Studies addressing Deaths of Despair according to geographical conditions.

Author	Year	Aim/s	Methods	Results	Race/ethnicity	Limitations	Sample, Year State/Region, Data Collection, Region
Monnat SM [20]	2020	To examine metropolitan versus non-metropolitan and intra-non-metropolitan all-cause-specific mortality trends among working age (25–64) non-Hispanic males and females 1990–2018.	Obtain all-cause and cause-specific mortality rates by sex and age group (25–44 and 45–64). Rates are age-adjusted within each 20-year age group using 10-year population counts and weights.	81% of the non-metropolitan mortality death rate increase is due to increases in drugs, alcohol, suicide, and mental/behavioral disorders (DoD).	The non-metropolitan working-age mortality penalty is growing for all ethnic groups and especially for non-Hispanic whites.	The study only examined the white population.The analysis did not adjust for compositional differences.The study only divided two-division and economic types.	9,211,413 deaths in metro counties and 2,465,300 deaths in nonmetro counties USA. Data were collected from 1990–2018.
Stein EM, et al. [25]	2017	To evaluate trends in premature deaths by cause of death, age, race, and urbanization level in the USA.	Calculate cause-specific death rates using Compressed Mortality File, National Center for Health Statistic data for adults 25 to 64 years [two periods 1999–2001 and 2013–2015]. Define 48 subpopulations	Death rates in rural subpopulations for all races/ethnicities increased among those aged 25 to 64 years by 6%, whereas large urban, suburban, and small or medium metropolitan subpopulations had decreases in death rates by 2% to 20%. These disparities were most pronounced in Whites relative to other racial/ethnic subpopulations and among those aged 45 to 54 years. Most increases in death rates were attributable to suicide, poisoning, and liver disease.	Deaths of despair were most pronounced among non-Hispanic whites relative to other racial groups.	The study was limited by the lack of information about the educational and economic status of descendants and the effects of racial/ethnic misclassification.	Sample size not available USA. Data were collected from 1999–2001 and 2013–2015.
Elo IT, et al. [21]	2019	Estimate the contributions of four key age groups to changes in life expectancy at birth between 1990 and 2016 by metropolitan-nonmetropolitan status and region.	Use of 1990–2016 Multiple Cause of Death data files to tabulate deaths by age, sex, race/ethnicity, cause of death, county, and year. These data were combined to estimate age-specific death rates for all causes.	Mortality from drug overdose, suicide, and alcohol-related causes of death increased and contributed to life expectancy reductions across the metropolitan and no-metropolitan categories, especially from a drug overdose.	The study only focused on non-Hispanic groups	Analyses did not adjust for compositional differences. The study focused on Non-Hispanic whites.	Sample size not available USA Data were collected from 1990–2016.