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A sixth of the U.S. population lives in a rural area. Those in rural areas face a disproportionate lack of access to physicians and acute emergency care, along with preventive medicine; one can make the reasonable assumption that those living in rural areas in other countries face similar conditions. This paper is centered around access to medical facilities, rurality, and place of death and utilizes data from the National Longitudinal Mortality Study. Stratified analyses were conducted based on age groups and cause of death. While the measured association between death in a medical facility and rurality in this study is somewhat weak, there is evidence that the association is stronger for older age groups. This links to issues within the eldercare system in the U.S. that have been exposed due to the ongoing pandemic and are augmented in rural areas, especially when medical issues such as strokes and heart attacks are considered. Follow-up research is being conducted in the international context, with an emphasis on Germany as a country of interest due to its rapidly aging population and national debates in recent years around palliative care, hospice, and physician-assisted death.

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Rurality Across the World: An Exploration of Access to Physicians in the Rural United States and Potential Applications Abroad