Analysis of the "rural mortality penalty" (and related impacts on the electorate?)

This is from a brief by Shannon Monnat of Syracuse University's Lerner Center for Public Health Promotion, under the headline, "The U.S. Rural Mortality Penalty is Wide and Growing": :  

After decades of lower or similar mortality rates in rural areas than in urban areas of the U.S., a rural mortality penalty emerged in the 1990s and has grown since the mid-2000s. Although the rural–urban mortality gap has widened across all major racial/ ethnic groups over the past 30 years, it has widened the most among working-age non-Hispanic (NH) whites. 

This brief summarizes the results from a study published in Population Research and Policy Review that examined rural urban differences in mortality rates overall and from 15 specific causes among working-age (age 25-64) NH whites1 from 1990 to 2018and identified the causes of death that have contributed most to the widening of the rural mortality penalty. 

Results show that the rural mortality penalty is wide and growing and is pronounced across multiple causes of death. Growth in the rural disadvantage is due to smaller rural declines in deaths from cancers and cardiovascular diseases and larger rural increases in deaths from metabolic, respiratory, alcohol related, and mental and behavioral diseases and suicides compared to urban areas. Mortality rate trends are particularly concerning for the younger working-age group (25-44) and for females overall. Ultimately, high and rising mortality rates across a variety of causes and rural places, some of which have been occurring since the 1990s and others that emerged more recently, suggest that there is not one underlying explanation. Instead, failures across a variety of institutions and policies have contributed to rural America’s troubling mortality trends. 

This New York Times story about how Trump's base is shrinking seems tragically related, in the sense that working-class/poorly educated whites are often associated with rural America. The lede follows:  

But in 2020, Mr. Trump and Joseph R. Biden Jr. face a drastically changed electorate. The cohort of non-college-educated white voters — who gave Mr. Trump just enough of a margin to win the election in 2016 — has been in a long-term decline, while both minority voters and white college-educated voters have steadily increased.

The decline, a demographic glacier driven largely by aging, has continued since 2016. The number of voting-age white Americans without college degrees has dropped by more than five million in the past four years, while the number of minority voters and college-educated white voters has collectively increased by more than 13 million in the same period. In key swing states, the changes far outstrip Mr. Trump’s narrow 2016 margins.

His campaign leaders are betting that a two-year grass-roots mobilization that has yielded significant voter registration gains will overcome the demographic disadvantage and the polls, again.

“As a clear show of support for the president’s policies, Americans are registering as Republican with a Republican president in office,” said Samantha Zager, a spokeswoman for the Trump campaign. “And those significant voter registration gains prove President Trump is expanding his base and will win four more years in the White House as a result.”