Rural Americans at greater risk of preventable deaths than city dwellers

Rural Americans die more often from potentially preventable causes than their urban counterparts, a new government study shows.

These causes include cancer, heart disease, injury, respiratory disease and stroke, according to U.S. Centers for Disease Control and Prevention research.

Between 2010 and 2017, rural counties saw a widening disparity in preventable deaths from cancer, heart disease and respiratory disease, compared to city areas. This is despite the fact that preventable cancer deaths fell to less than 10 percent of all nationwide deaths from cancer in 2017.

"We are encouraged to find that preventable deaths from cancer have gone down overall, yet there is a persistent and striking gap between rural and urban Americans for this and other leading causes of death," CDC Director Dr. Robert Redfield said in an agency news release. The rural/urban difference remained about the same for deaths due to stroke but narrowed for unintentional injuries. Researchers said the shrinking gap for preventable injuries didn't stem from improvements in rural areas. Instead, they attributed it to a spike in urban areas, largely due to the opioid crisis.

Using data from the National Vital Statistics System, CDC researchers calculated potentially preventable deaths for people under age 80.

The researchers were able to drill down beyond a distinction of urban and rural to finer categories. These included large urban areas, fringe metropolitan, medium metro, small metro, micropolitan and rural areas.

The southeastern United States had the highest number of preventable deaths, according to the report.

In 2017, 22 percent of cancer deaths in the most rural counties were potentially preventable, compared to 29 percent in 2010. In the most urban areas, 3 percent of cancer deaths were potentially preventable in 2017, compared to 18 percent in 2010.
In both 2010 and 2017, 45 percent of heart disease deaths in rural counties were deemed potentially preventable -- compared to 24 percent in large fringe metro areas in 2010 and 19 percent in 2017.
In 2010, 61 percent of deaths from unintentional injury were potentially preventable in the most rural counties, compared with 25 percent in the most urban. By 2017, that rose to 64 percent in rural counties and 48 percent in urban areas.
In 2017, 57 percent of rural deaths from chronic respiratory disease were potentially preventable, up from 54 percent in 2010. That compared to 13 percent in the most urban counties in 2017 and 23 percent in 2010.
In 2017, 38 percent of stroke deaths in rural counties were potentially preventable, compared to 42 percent in 2010. In large fringe metro areas, 23 percent were potentially preventable in 2010 and 17 percent in 2017.

Closing the gaps starts with recognizing that people in rural areas tend to be older and sicker than people in cities, the CDC said. Compared to city dwellers, rural Americans smoke more, have higher rates of obesity, report less physical activity during leisure time and are less likely to buckle up when they drive.

They're also poorer, have less access to health care and are less likely to have health insurance.

To combat these problems, the CDC urged health care providers in rural areas to make blood pressure and cancer screening a priority. The agency also called on people in rural areas to get more active, eat healthier, lose weight, quit smoking and wear seat belts.

Researchers added that doctors should be more careful when prescribing opioids.

The report was published Nov. 8 in the CDC's Morbidity and Mortality Weekly Report.

More information

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