New CDC Study Finds Big Difference Between Rural and Urban Mortality Rates

Rural America In These Times January 13, 2017

The "stroke belt" is typically defined to include the states of Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, and Virginia. In 1980, these eleven states had age-adjusted stroke mortality rates more than 10 percent above the national average.

From 1999 to 2014, the Cen­ters for Dis­ease Con­trol and Pre­ven­tion (CDC) tracked the lead­ing caus­es of death in non­metro­pol­i­tan and met­ro­pol­i­tan areas in the Unit­ed States. They com­pared the region­al mor­tal­i­ty data to deter­mine how many deaths could like­ly have been pre­vent­ed, assum­ing the death rates of states with the low­est rates occurred across all states.

The report finds not only that unin­ten­tion­al injury deaths are near­ly 50 per­cent more like­ly in rur­al areas than they are in cities, but that dis­tance to emer­gency med­ical care, the ongo­ing opi­od cri­sis, obe­si­ty rates and oth­er fac­tors all leave rur­al Amer­i­cans at high­er risk of ear­ly death. Below is the CDC’s full press release and links to their research. 

Press release: Rur­al Amer­i­cans at high­er risk of death from five lead­ing causes

A new CDC study demon­strates that Amer­i­cans liv­ing in rur­al areas are more like­ly to die from five lead­ing caus­es than their urban coun­ter­parts. In 2014, many deaths among rur­al Amer­i­cans were poten­tial­ly pre­ventable, includ­ing 25,000 from heart dis­ease, 19,000 from can­cer, 12,000 from unin­ten­tion­al injuries, 11,000 from chron­ic low­er res­pi­ra­to­ry dis­ease, and 4,000 from stroke. The per­cent­ages of deaths that were poten­tial­ly pre­ventable were high­er in rur­al areas than in urban areas. The report and a com­pan­ion com­men­tary are part of a new rur­al health series in CDC’s Mor­bid­i­ty and Mor­tal­i­ty Week­ly Report.

This new study shows there is a strik­ing gap in health between rur­al and urban Amer­i­cans,” said CDC Direc­tor Tom Frieden, M.D., M.P.H. To close this gap, we are work­ing to bet­ter under­stand and address the health threats that put rur­al Amer­i­cans at increased risk of ear­ly death.”

Some 46 mil­lion Amer­i­cans — 15 per­cent of the U.S. pop­u­la­tion — cur­rent­ly live in rur­al areas. Sev­er­al demo­graph­ic, envi­ron­men­tal, eco­nom­ic, and social fac­tors might put rur­al res­i­dents at high­er risk of death from these pub­lic health con­di­tions. Res­i­dents of rur­al areas in the Unit­ed States tend to be old­er and sick­er than their urban coun­ter­parts. They have high­er rates of cig­a­rette smok­ing, high blood pres­sure, and obe­si­ty. Rur­al res­i­dents report less leisure-time phys­i­cal activ­i­ty and low­er seat­belt use than their urban coun­ter­parts. They also have high­er rates of pover­ty, less access to health­care, and are less like­ly to have health insurance.

The Health Resources and Ser­vices Admin­is­tra­tion (HRSA), which hous­es the Fed­er­al Office of Rur­al Health Pol­i­cy, will col­lab­o­rate with CDC on the series and will help to pro­mote the find­ings and rec­om­men­da­tions to rur­al communities. 

We have seen increas­ing rur­al-urban dis­par­i­ties in life expectan­cy and mor­tal­i­ty emerge in the past few years. CDC’s focus on these crit­i­cal rur­al health issues comes at an impor­tant time,” said Health Resources and Ser­vices Admin­is­tra­tion (HRSA) Act­ing Admin­is­tra­tor Jim Macrae. 

In the study, mor­tal­i­ty data for U.S. res­i­dents was ana­lyzed from the Nation­al Vital Sta­tis­tics Sys­tem.

Coun­ties were placed in two cat­e­gories — urban or rur­al — based on the NCHS urban-rur­al clas­si­fi­ca­tion scheme for coun­ties. The cur­rent study found that unin­ten­tion­al injury deaths were approx­i­mate­ly 50 per­cent high­er in rur­al areas than in urban areas, part­ly due to greater risk of death from motor vehi­cle crash­es and opi­oid over­dos­es. Also, because of the dis­tance between health­care facil­i­ties and trau­ma cen­ters, rapid access to spe­cial­ized care can be more chal­leng­ing for peo­ple injured in rur­al areas.

The gaps in health can be addressed. For exam­ple, health­care providers in rur­al areas can:

  • Screen patients for high blood pres­sure and make con­trol a qual­i­ty improve­ment goal. High blood pres­sure is a lead­ing risk fac­tor for heart dis­ease and stroke.
  • Increase can­cer pre­ven­tion and ear­ly detec­tion. Rur­al health­care providers should par­tic­i­pate in the state-lev­el com­pre­hen­sive con­trol coali­tions. Com­pre­hen­sive can­cer con­trol pro­grams focus on can­cer pre­ven­tion, edu­ca­tion, screen­ing, access to care, sup­port for can­cer sur­vivors, and over­all good health.
  • Encour­age phys­i­cal activ­i­ty and healthy eat­ing to reduce obe­si­ty. Obe­si­ty has been linked to a vari­ety of seri­ous chron­ic ill­ness­es, includ­ing dia­betes, heart dis­ease, can­cer, and arthritis.
  • Pro­mote smok­ing ces­sa­tion. Cig­a­rette smok­ing is the lead­ing cause of pre­ventable dis­ease and death in the Unit­ed States and is the most sig­nif­i­cant risk fac­tor for chron­ic low­er res­pi­ra­to­ry disease.
  • Pro­mote motor vehi­cle safe­ty. Rur­al health­care providers should encour­age patients to always wear a seat belt and coun­sel par­ents and child care providers to use age- and size-appro­pri­ate car seats, boost­er seats, and seat belts on every trip.
  • Engage in safer pre­scrib­ing of opi­oids for pain. Health­care providers should fol­low the CDC guide­line when pre­scrib­ing opi­oids for chron­ic pain and edu­cate patients on the risks and ben­e­fits of opi­oids and using non­phar­ma­co­log­ic ther­a­pies to pro­vide greater benefit.

Not all deaths can be pre­vent­ed. Some rur­al areas might have char­ac­ter­is­tics that put res­i­dents at high­er risk of death, such as long trav­el dis­tances to spe­cial­ty and emer­gency care or expo­sures to spe­cif­ic envi­ron­men­tal haz­ards. It’s also pos­si­ble that exces­sive­ly high death rates could sig­nal a need for improved pub­lic health pro­grams that sup­port health­i­er behav­iors and neigh­bor­hoods or bet­ter access to health care services.

Graphs depict­ing the five lead­ing caus­es of death as tracked in rur­al and urban areas by the CDC from 1999 to 2014. (Image: Google Images)

To read the entire report and com­pan­ion com­men­tary: www​.cdc​.gov/mmwr.

For more infor­ma­tion on rur­al health: www​.hrsa​.gov/​r​u​r​a​l​h​ealth.

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