Patients in rural areas more likely to die early from preventable deaths

Key takeaways:

• Rural Americans are more likely to die early from one of the leading causes of death, even though urban residents far outnumber them.
• However, a multipronged approach could improve the disparities.

Those who live in rural areas face a higher risk for dying early from preventable deaths, but primary care providers can implement strategies to reduce these disparities, experts said during a CDC press conference.

The CDC began assessing mortality disparities among rural and urban areas in 2016, Macarena C. García, DrPH, MPS, MIS, senior health scientist for the CDC’s Office of Rural Health, said in the briefing. They calculated the number of potentially preventable deaths for the top five causes from 2010 through 2017, then updated that data through 2022 to evaluate trends over time.

“Overall, we estimated that 6.37 million people died prematurely from preventable causes from the five leading causes of death during the 12-year study period,” Garcia said. “This number is higher than the entire population of the state of Maryland.”

As of 2022, more than 15% of the U.S. population — at least 46 million Americans — lived in rural areas. Compared with their urban counterparts, they faced higher odds of dying early from one of the top five causes of death:

• heart disease;
• cancer;
• unintentional injuries (including overdose deaths and other unintentional poisonings, motor vehicle accidents, drowning, suffocation, falls and accidental firearm discharges);
• stroke; and
• chronic lower respiratory disease (mostly chronic bronchitis, emphysema and asthma)

The CDC excluded COVID-19 “to maintain consistency and facilitate the assessment of trends over time,” Garcia said.

“Although urban residents far outnumber rural ones, rural Americans are at a higher risk of dying early from preventable deaths from the five leading causes,” Garcia said.

Garcia noted that Utah, Minnesota and Colorado were the states with the lowest age-adjusted mortality rate for heart disease, whereas Mississippi had the highest mortality rate for heart disease in the country.

“From our analysis, and this is very consistent with our analysis that we conducted previously from 2010 to 2017, the southeastern part of the United States is really the area that has the highest prevalence or proportions of preventable early deaths,” she said. “We see that pretty consistently. However, that does shift depending on the cause of death, so every condition has a different geographic variation in the country.”

For more information on data in specific states, CDC officials also announced an interactive platform, which can be found here.

The proportion of preventable early deaths also varies by cause, according to Garcia. For example, in 2022, more than 60% of early deaths from unintentional injuries were preventable.

“For stroke and heart disease, it was closer to 34%,” Garcia said. “For chronic lower respiratory disease, the proportion was 26%.”

In more positive news, Garcia said “the U.S. benchmark for preventable early deaths from cancer has nearly been achieved.” But of course, “that doesn't mean there are no more preventable early deaths for cancer.”

“This means that, on average, the United States has almost achieved the mortality rates of the three states with the lowest mortality rates for cancer,” she said.

Garcia said the findings describe an urban/rural divide in the U.S., “where rural residents tend to be sicker and poorer and have worse health outcomes than their non-rural peers.” However, she stressed that “rural challenges are not uniform and are complicated by geographic characteristics.”

“Race, too, complicates the issue,” she said. “Disparities across race and ethnicity interact with morality to create regional patterns of inequality and inequity across the U.S. We're conducting further research on the association between interactions of gender, race ethnicity ... and preventable early death.”

Many efforts are underway to address these disparities, Garcia said. The CDC is funding public health programs in rural communities, developing resources for rural health needs, expanding outreach and engagement in these communities and more, she said.

“We recommend a multipronged approach to addressing the structural inequities,” Garcia said. “This includes strengthening rural institutions, including local public health departments, addressing predictors of health and leveraging rural strengths and assets, such as high levels of social connectedness, self-reliance and a shared history.”

Some specific strategies “we can support as public health practitioners,” include hypertension screening and making its management a quality improvement goal, increasing early cancer detection, encouraging improved nutrition and fitness, promoting motor vehicle safety, smoking cessation and “engaging in safer prescribing of opioids for pain,” she said.

“We believe these findings can help guide [and] focus public health interventions at the local and community levels to effectively reduce the risks of premature death,” she said. “The findings also suggest a need to better understand potential shifts in social, environmental and structural inequities, contributing to disparities in preventable early deaths between rural and urban areas.”

References:

• Death (leading causes). https://www.cdc.gov/ruralhealth/cause-of-death.html. Published April 30, 2024. Accessed April 30, 2024.
• Garcia MC, et al. MMWR. 2024;doi:10.15585/mmwr.ss7302a1.
• Interactive dashboard. https://public.tableau.com/app/profile/macarena.garcia4428/viz/PreventableEarlyDeathsintheUnitedStates2010-2022/ss1_mapview_final. Published April 30, 2024. Accessed April 30, 2024.