Disparities in Premature Deaths: Addressing Rural-Urban Health Gaps
Rural-urban disparities in preventable premature deaths have long been a substantial concern in the United States. Studies have consistently shown that residents in noncore counties, particularly those in rural areas, have experienced alarmingly high percentages of premature deaths (11). The underlying causes of these disparities extend far beyond just the place of residence. Demographic factors such as sex, race, and ethnicity also contribute to the disparities in all-cause premature deaths (11).
A recent in-depth analysis highlights the grim reality that the highest rates of premature deaths are observed in rural counties with a larger population of Black, African American, American Indian, or Alaska Native individuals (11). To bridge the significant gaps in preventable premature deaths between rural and urban counties, it is crucial to have comprehensive data on cause-specific premature deaths. This data should consider rural-urban county category, race, and ethnicity. By identifying the leading causes and variations in premature deaths within specific racial and ethnic groups, interventions and policies can be tailored to address the specific needs of these communities. The importance of these data-driven approaches cannot be emphasized enough, as they provide the necessary evidence to guide both existing and novel programs and policies.
Cancer: A Steady Decline in Premature Deaths
A notable shift has been observed in the preventable premature deaths from cancer – a decrease worth acknowledging. The most substantial decrease has been witnessed in urban counties, where the access to preventive services, treatment, survivor care, and specialty care is significantly higher compared to their rural counterparts (19). Large central and fringe metropolitan areas have achieved benchmark rates, reflecting the overall decline in cancer mortality, which has decreased by 27% between 2001 and 2020 (20).
The promising decrease in preventable premature deaths can be attributed to multiple factors. The promotion of recommended screening methods for leading cancer types, such as lung, colon, cervical, and female breast cancers, has resulted in early detection and improved treatment outcomes. Similarly, vaccination rates against cancer-causing viruses have risen, and there has been a decrease in the prevalence of risk factors like tobacco use (21). The expansion of Medicaid has also significantly increased access to cancer prevention and early detection strategies (23). Moreover, the advancements in cancer treatments, especially for lung cancer and melanoma, have contributed to longer survival rates for patients (24). Although the current analysis categorizes cancer as a single disease group, it is important to emphasize that each cancer site has distinct risk factors, treatment methods, and manifestations. Therefore, preventable premature death rates may vary depending on specific cancer types that may not yet demonstrate the same level of progress.
Despite the overall decline, rural and less-populated counties continue to grapple with cancer-related premature deaths that surpass the national average. The limited access to lung cancer screening facilities in these areas partially contributes to the higher lung cancer mortality rates (26). Therefore, there remains an urgent need to focus on reducing cancer-related premature deaths in rural areas as future updates to cancer-specific benchmarks can better reflect the desired progress by considering the most recent years of data.
Unintentional Injury: Battling Rising Mortality
The alarming rise in preventable premature deaths from unintentional injuries paints a distressing picture. The drug overdose epidemic, increased motor vehicle traffic fatalities, and falls have contributed significantly to the rising mortality rates (27). However, it is noteworthy that the narrowing rural-urban disparities are primarily driven by worsening rates of preventable deaths in more urban areas, particularly large central metropolitan areas, where the percentage of premature deaths more than doubled during the study period.
Access to medications for opioid use disorder continues to be limited in rural counties, as indicated by low buprenorphine dispensing rates and reduced treatment capacity. This contributes to the higher rates of drug overdoses in rural areas (28). Additionally, rural residents are more at risk of traffic crash deaths and are often less likely to use seat belts compared to their urban counterparts (29). Implementing evidence-based interventions such as promoting seat belt use can effectively reduce rural-urban disparities in motor vehicle death rates (30). It is important to recognize that many fall risk factors are preventable, emphasizing the need for improved fall prevention strategies (31).
Heart Disease and Stroke: Unyielding Disparities
Disparities in preventable premature deaths from heart disease and stroke persist between rural and urban areas. These gaps have notably widened from 2019 to June 2022. However, there has been a slight decrease of three percentage points in large central metropolitan counties from 2020 to 2021. These dynamics can be attributed to COVID-19-related conditions, which have contributed to increased mortality rates for heart disease and stroke (32).
A distressing trend observed during the COVID-19 pandemic is the elevation of systolic and diastolic blood pressure in all age groups (33). This increase in blood pressure further exacerbates the risk factors associated with heart disease and stroke. Additionally, the pandemic exposed inequities in hypertension control, resulting from factors such as limited healthcare access, medication adherence, and monitoring (34). Some individuals may have also hesitated to seek emergency care during life-threatening events, which contributed to the reduced emergency department visits and hospital admissions for heart attack and stroke (35). Furthermore, the increased risk of stroke and heart disease linked to COVID-19 has further compounded the issue (36,37).
Chronic Lower Respiratory Disease: Seeking Stability
The overall decrease in preventable premature deaths from chronic lower respiratory disease (CLRD) has only been observed in larger urban areas during the study period of 2010–2020. However, the percentage of preventable premature deaths in medium and small urban counties, as well as rural counties, has remained relatively stable (38). It is important to note that the observed decline during 2019–2021 in urban areas could be attributed to deaths from COVID-19 that otherwise might have been classified as CLRD-related. It is worth mentioning that individuals suffering from CLRD, like chronic obstructive pulmonary disease (COPD), face an increased risk of death from COVID-19 (38).
As the data unfolds the stark disparities, it is evident that addressing the rural-urban health gaps in preventable premature deaths requires targeted interventions and policies. Delving deeper into cause-specific premature deaths by considering factors such as race, ethnicity, and rural-urban county category will provide essential insights for tailoring interventions to the specific needs of communities. It is not only an opportunity to confront the tragic loss of lives but also a chance to nurture a healthier and more equitable future for all.
