Rural U.S. residents have higher rates of preventable premature deaths, CDC report finds

Rural residents of the United States often experience higher rates of premature death and poorer health compared to those living in urban areas. Despite demographic and population changes, local public health remains a concern and efforts to address preventable premature deaths require continued vigilance, according to the CDC.

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One report shows that non-metropolitan areas have higher rates of preventable deaths than metropolitan areas in the United States. CDC Morbidity and Mortality Weekly Report Researchers used mortality data to estimate the number of deaths and death rates from five leading causes of death: heart disease, cancer, unintentional injury, chronic lower respiratory disease (CLRD), and stroke. These could have been prevented if death rates were similarly low in all states. Fee. The report also estimates disparities in early mortality rates for five causes of death in rural America from 2010 to 2022.

This analysis uses mortality data for U.S. residents from the National Vital Statistics System to identify preventable premature deaths by urban and rural county classification from 2010 to 2022 from the five leading causes of death. I calculated it. excluded from analysis. Those who were over 80 years old at the time of death were not included in the analysis, which is consistent with the average life expectancy of the U.S. population in 2010 (approximately 79 years).

Additionally, age groups differed by cause of death, with most cases having an age difference of 10 years. However, the youngest age range ranged from 0 to 9 years in the unintentional injury group, and the largest gap was from 0 to 49 years in the CLRD and CLRD groups. According to the authors, these deaths are rare in young people and therefore fall under the cerebrovascular disease group. Additionally, for each age group and cause of death, he created a benchmark rate by averaging the mortality rates of the three states that had the lowest death rates from 2008 to 2010, and used this to At the start, each state represented the lowest achievable mortality rate. study period. Benchmarks apply to both nonmetropolitan and metropolitan counties and do not adjust for other characteristics that may influence mortality rates (e.g., race, socioeconomic status, urbanicity). It was.

In addition, rural and urban categories were identified using the National Center for Health Statistics' 2013 urban-rural county 6-point classification system. Large central metropolis/most urban area (1), large peripheral metropolitan area (2), medium metropolitan area (3), small metropolitan area (4), small metropolitan area (5), non-urban area Core/most rural (6). Preventable premature deaths were calculated separately for the two nonmetropolitan categories (numbers 5 and 6 on the scale) and the four metropolitan categories (numbers 1 to 4 on the scale).

This finding suggests that rural residents, particularly those living in non-core/mostly rural counties, had higher rates of preventable early death during the analysis period and that disparities in early death vary by cause of death. It was shown. Despite the differences observed in the findings, they were not limited to place of residence. Additionally, early all-cause mortality was often associated with other demographic factors such as gender, race, and ethnicity.

Cancer-related deaths decreased over the study period (from 21% to 0.3%), regardless of county classification. However, the decline in urban areas was greater than that observed in rural counties. Furthermore, the number of preventable premature cancer deaths in non-core/mostly rural areas in 2022 (18.1%) is very similar to that shown in central metropolitan counties in 2010 (17.9%). I was there.

Preventable premature deaths related to heart disease decreased from 2010 (33.5%) to 2019 (28.8%) but increased from 2020 to June 2022 (33.6%) . Notably, increases from 2020 to June 2022 occurred in all county categories except central metropolitan areas, which decreased from 2020 (32.9%) to 2021 (30.1%). Preventable premature deaths related to heart disease were highest in rural counties in 2022 (small cities: 45.8%, non-core/most rural counties: 49.4%).

The number of unintentional deaths increased from 2010 to 2019 (from 38.8% to 53.8%), continued to increase significantly until 2021, and then slightly decreased until June 2022 (63.5%). %). From 2010 to 2022, the increase in preventable premature deaths from unintentional injuries was significant in nearly every category except small cities, although rates were higher in rural areas than in urban areas.

The proportion of preventable premature deaths associated with CLRD decreased from 2010 to 2022 (from 38.6% to 25.5%), and the proportion of preventable premature deaths varied significantly when stratified by rural and urban county categories. However, all categories except non-core/most rural and experienced have declined. Inequality widened as the share in metropolitan centers decreased from 2010 (23.4%) to 2022 (0%), while the share in rural areas ranged from 50.7% to 54.8% in 2022. did.

Preventable premature deaths from stroke decreased from 2010 (32.4%) to 2019 (26.4%) and then increased until June 2022 (33.9%). Additionally, each category of rural and urban areas increased from 2019 to June 2022. However, there was a slight decrease in non-core/most rural counties from 2021 to June 2022, with rural counties having the highest percentage from January to June 2022 (small cities: 42.0%, non-core /Most rural areas: 40.9%). The highest number of preventable stroke-related premature deaths in 2022 occurred in southern states, researchers said.

Limitations of this study include the application of benchmarks to all urban and rural categories and the inability to fully categorize deaths by population size or geographic location (risk factors do not occur randomly within a population). (not related to external factors), and estimates. Preventable early deaths using benchmarks may not accurately reflect improvements in mortality that occur later in life. Additionally, researchers note that even if they try to exclude COVID-19 from the data, some deaths may still be driven by COVID-19 and the pandemic. Additionally, misclassification of deaths may have occurred, limiting deaths due to pandemic-related effects, such as reduced access to emergency and life-saving care due to COVID-19.

The authors believe that reporting trends in preventable early deaths can highlight differences over time and provide a deeper understanding of underlying social, environmental and structural risk factors. It is pointed out that it is helpful. It also emphasizes the need to conduct a more detailed analysis, including preventable premature deaths related to race, age, ethnicity, preventable deaths in people 80 and older, and other causes.

reference

Garcia, MC, Rossen, LM, Matthews, K, et al. Preventable premature deaths from five leading causes of death in U.S. nonmetropolitan and metropolitan counties, 2010–2022. MMWR monitoring total 2024;73(No.SS-2):1–11. doi:10.15585/mmwr.ss7302a1.