Rural Americans more likely to die early from preventable causes, CDC reports

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The 46 million Americans who lived in rural parts of the country in 2022 were more likely to die before their 80th birthday from one of the top causes of death — heart disease, cancer, unintentional injury, stroke or chronic lower respiratory disease — than people who lived in urban or suburban areas, according to new data from the U.S. Centers for Disease Control and Prevention.

Many of those early deaths, the CDC said, were preventable.

"There is a well-described rural-urban divide in the United States, where rural residents tend to be sicker and poorer and have worse health outcomes than do their nonrural peers," said Macarena García, a senior health scientist at the CDC's Office of Rural Health in Atlanta.

"The reasons are very similar for many of the conditions, but for cancer specifically, we have to remember that screening, prevention services as well as treatment services are much more accessible in urban areas. So that means they are limited in rural areas.

"Sometimes. people have to drive two, three hours to the nearest center that provides specialty care. So that means people go without preventive services. People in rural areas likely have lower rates of screening and certainly have less access to treatment."

Lack of access to health care for the 15% of Americans who live in rural parts of the country has been exacerbated by hospital closures, according to the University of North Carolina's Cecil G. Sheps Center for Health Services Research. Since 2010, 148 hospitals in rural communities either closed completely or no longer offer acute inpatient care, switching instead to provide other health services, such as urgent care or long-term care.

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Of them, four are in Michigan — Aspirus Ontonagon Hospital, Spectrum Health Kelsey Hospital, Cheboygan Memorial Hospital and Leelanau Memorial Health Center.

From 2010-22, CDC researchers also found:

• Premature heart disease deaths rose more than 9% in the nation's rural communities, but fell by more than 10% in urban areas.
• The rate of death before the age of 80 from cancer decreased nationally in both rural and urban parts of the U.S. However, the biggest declines in cancer deaths occurred in large metropolitan and suburban communities, further exacerbating the rural-urban mortality divide.
• Deaths from unintentional injuries, which included drug overdoses and other types of poisoning, traffic crashes, drowning, suffocation, accidental firearm discharges and falls, rose in both rural and urban areas of the U.S. The largest increases occurred in metropolitan and suburban regions, which tightened the rural-urban divide in this category. However, deaths from unintentional injuries among rural Americans remained higher than among urban and suburban residents.

"The poisonings that are mentioned in the unintentional injury category are referring to drug overdose deaths and as we've seen in recent years, drug overdose deaths — about 75% — have … involved opioids, many of which involve illegally manufactured fentanyl," said Gery Guy, the lead health scientist at the CDC's division of overdose prevention. "That's what's driving a lot of the trends that we saw in this analysis."

The coronavirus, which was the fourth-leading cause of death in 2022, was excluded from the study, García said. That's because the research began years before the virus that causes COVID-19 was identified in the U.S. in January 2020.

"There's no historical data," García said, "so we couldn't assess trends over time. ... The other reason is because the way that you calculate excess deaths for COVID, which is a public health emergency, is very different than the methodology we use to calculate preventable early deaths for chronic diseases. So it really would be like comparing apples and oranges."

The highest rates of premature preventable death, the study found, were in rural communities where the majority of the population was Black, African American, American Indian or Alaska Native.

"Race, too, complicates the issue," García said. "Disparities across race and ethnicity interact with rurality to create regional patterns of inequality and inequity across the U.S. We are conducting further research on the association between interactions of gender, race, ethnicity and ... preventable early death."

More must be done, she said, to close the gap between rural America and urban parts of the country, and reduce the rate of premature preventable death, overall, nationally.

"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," García said. "This number is higher than the entire population of the state of Maryland.

"More than 60% of early deaths from unintentional injuries in 2022 were preventable. For stroke and heart disease, it was closer to 34%. For chronic lower respiratory disease, the proportion was 26%. Chronic bronchitis, emphysema, and asthma are the most common diseases within the chronic lower respiratory disease category."

Improving access to health care, Guy said, especially for people who have opioid use disorder, could go a long way in reducing rates of premature unintentional death.

"There's proven, approved medication to treat opioid use disorder," he said. "It remains underutilized, not just in rural areas, but across the country. So increasing uptake of treatment is one important factor to help reduce those deaths."

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CDC also is focused on boosting funding for local health departments and rural health initiatives to provide screening of patients for high blood pressure, cancer prevention and early detection, García said, as well as on advancing telehealth options and boosting broadband access in rural areas.

"We recommend a multipronged approach to addressing the structural inequities," she said, which includes encouraging physical activity and healthy eating, smoking cessation, the use of child safety seats and seat belts, as well as safer prescribing of opioids for pain.

Contact Kristen Shamus: kshamus@freepress.com. Subscribe to the Free Press.