November 12, 2019

U.S. residents living in rural areas of the country were more likely to die from preventable causes than those living in urban areas from 2010 to 2017, according to a CDC Morbidity and Mortality Weekly Report (MMWR) released Friday.

10 tools for prioritizing community health interventions

Report details

The report builds on a 2017 CDC report that found a higher share of U.S. residents in rural areas died from preventable causes when compared with U.S. residents in urban areas from 2010 to 2014.

For the latest report, researchers examined National Vital Statistics System mortality data from 2010 to 2017 to calculate the five leading causes of preventable deaths among U.S. residents under the age of 80. The researchers used a six-level, urban-rural classification scheme developed by the National Center for Health Statistics to analyze the data.

Findings

Overall, the researchers found heart disease, cancer, unintentional injury, chronic lower respiratory disease (CLRD), and stroke ranked as the five leading causes of death in the United States in 2017.

The researchers found the five leading causes of death accounted for 1.72 million deaths, or about 61% of all deaths, in the United States in 2017. According to the researchers, heart disease and cancer accounted for 44% of all deaths in 2017.

The researchers found that, from 2010 to 2017, the number of preventable deaths among U.S. residents under age 80 from cancer decreased by 9.1%. However, over that same time, the number of preventable deaths among U.S. residents under age 80 from:

  • CLRD increased by 1.7%;
  • Heart disease increased by 1.1%;
  • Stroke increased by 0.3%; and
  • Unintentional injuries increased by 11.2%.

According to the researchers, rural areas experienced larger shares of preventable deaths than urban areas from 2010 to 2017. The researchers found that "[t]he gap between the most rural and most urban counties for potentially" preventable deaths increased from 2010 to 2017 for cancer, heart disease, and CLRD, but decreased for unintentional injuries and remained relatively unchanged for stroke:

Specifically, the researchers found 22% of cancer deaths in rural counties in 2017 had been preventable, compared with 3% of cancer deaths in urban counties. Similarly, the researchers found 45% of heart disease deaths in rural counties in 2017 had been preventable, compared with 19% of heart disease deaths in urban communities.

According to the researchers, the gap between rural and urban areas for preventable unintentional injury deaths narrowed because of an increase in deaths related to the opioid epidemic in urban areas. The percentage of potentially preventable unintentional injury deaths increased from 61% in the most rural counties and 25% in the most urban counties in 2010 to 64% in the most rural counties and 48% in the most urban counties in 2017.

Overall, the researchers found that rural areas in the southeastern portion of the United States had the highest number of preventable deaths in 2017 when compared with other areas.

How to address the disparities

The researchers recommended health departments track preventable deaths to identify and monitor public health problems and focused interventions. They noted there are certain distinctions between U.S. residents living in rural areas and those living in urban areas, including that U.S. residents in rural areas tend to be older and sicker than their urban counterparts. The researchers called on public health officials to recognize those differences and prioritize the needs of U.S. residents in rural areas, such as by prioritizing blood pressure and cancer screenings in those areas (CBS/WCBI, 11/8; Masson, Becker's Hospital Review, 11/8; Owens, "Vitals," Axios, 11/8; CDC's MMWR, 11/8).

10 tools for prioritizing community health interventions

The impact of social factors such as food insecurity, poverty, and transportation on health status is undeniable. Extensive research estimates that up to 20 percent of health outcomes are a result of social and environmental risk factors. To address patients’ unmet social needs before an acute care episode, population health managers increasingly extend care model interventions into the community.

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