Rural Americans Face Higher Risk of Death From Five Leading Causes

Demographic, environmental, economic, and social factors may play a part

A new Centers for Disease Control and Prevention (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, MD, MPH. “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% of the U.S. population—live in rural areas. Several demographic, environmental, economic, and social factors might put rural residents at higher risk of death from these 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 health care, and are less likely to have health insurance. Increasing rural–urban disparities in life expectancy have emerged in the past few years.

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

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 National Center for Health Statistics urban–rural classification scheme for counties. The study found that unintentional injury deaths were approximately 50% 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 health care facilities and trauma centers, rapid access to specialized care can be more challenging for people injured in rural areas.

To help address such gaps, health care 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 health care providers should participate in state-level comprehensive control coalitions that focus on cancer prevention, education, screening, access to care, survivor support, and overall good health.
  • Encourage physical activity and healthy eating to reduce obesity, which has been linked to a variety of serious chronic illnesses.
  • Promote smoking cessation. Cigarette smoking is the leading cause of preventable disease and death in the United States.
  • Promote motor vehicle safety. Rural health care providers should encourage patients to always wear a seatbelt and counsel parents and child care providers to use appropriate car seats, booster seats, and seatbelts on every trip.
  • Engage in safer prescribing of opioids for pain. Health care providers should follow the CDC guideline when prescribing opioids for chronic pain and should educate patients on the risks and benefits of opioids and using nonpharmacological 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.

Sources: CDC; January 12, 2017; MMWR; January 12, 2017.