Disparities in Preventable Premature Deaths Across Urban-Rural Divides in the United States
Introduction: A 2019 report highlighted the stark contrast in potentially avoidable deaths between rural and urban areas in the United States. This study expands on that analysis, covering the period from 2010 to 2022.
Methodology: Utilizing mortality data from the National Vital Statistics System, this study calculated preventable premature deaths among individuals under 80 years old, focusing on the five leading causes of death. The CDC’s urban-rural classification system categorized deaths based on the decedent’s county of residence. Preventable premature deaths were defined as those exceeding the expected number if death rates were equal to those in benchmark states with the lowest rates.
Key Findings: From 2010 to 2022, preventable premature deaths increased for unintentional injury and stroke but decreased for cancer and chronic lower respiratory disease (CLRD), while remaining stable for heart disease. Rural counties consistently exhibited higher percentages of preventable premature deaths across all years. Specifically, noncore counties experienced the highest rates, surpassing large metropolitan areas.
Trends: Heart disease preventable deaths increased most significantly in noncore and micropolitan counties, while cancer deaths decreased across all county categories. Unintentional injury deaths surged, especially in large metropolitan areas. CLRD deaths decreased in large central metropolitan counties but saw a slight increase in noncore counties. Stroke deaths initially decreased but spiked in 2020, coinciding with the COVID-19 pandemic.
Regional Disparities: Disparities persisted across states, with rural counties consistently bearing a higher burden of preventable deaths compared to urban counterparts.
Interpretation: The widening gap between rural and urban areas underscores the need for targeted interventions. The observed increases in preventable deaths from various causes, particularly during the COVID-19 pandemic, emphasize the urgency of addressing healthcare access and social determinants of health in underserved communities.
Public Health Implications: Routine monitoring of preventable premature deaths by urban-rural classification can aid public health departments in identifying and addressing geographic disparities. This approach can inform targeted interventions aimed at reducing preventable mortality and improving overall population health.
