discussion
Rural residents, particularly those in non-core counties, experienced higher rates of preventable premature deaths during the study period. Rural-urban disparities in early death varied by cause of death. However, the disparity was not limited to residence. Differences in premature death due to all causes were also associated with other demographic factors (e.g., gender, race, ethnicity) (11). For example, the highest early mortality rates were observed in rural counties where the majority of the population was Black, African American, American Indian, or Alaska Native (11). To address the disparity in preventable premature deaths between rural and urban counties, we can analyze disparities by rural and urban county category, race, and ethnicity to inform race-specific interventions and health policy. Data are needed on disparities in premature death by cause from the five main causes of death. and ethnic groups. Follow-up of this analysis, stratified by race and ethnicity, will be presented in a future report and will further contribute to the evidence to guide existing and new programs and policies.
cancer
Overall, the reduction in premature deaths from preventable cancers was large and greatest in urban counties, where access to preventive services, treatment, survivorship care, and specialty care is much higher than in rural counties. (19). In 2019, metropolitan centers and peripheral metropolitan areas achieved benchmark rates. This is consistent with an overall decline in cancer mortality rates, which decreased by 27% between 2001 and 2020 (20). The decline in preventable premature deaths likely reflects multiple factors. Increasing recommended screening for the leading causes of death from cancer (lung, colon, cervix, female breast, etc.) allows for early detection when treatment is more effective, and the detection of cells before they turn into cancer. Prevention is now possible by detecting changes in For colorectal cancer (twenty one). Increased vaccination rates for carcinogenic viruses and decreased prevalence of risk factors (such as combustible tobacco use) have also reduced cancer mortality (twenty two). Medicaid expansion has increased access to these cancer prevention and early detection strategies (twenty three). New cancer treatments and treatments, particularly for lung cancer and melanoma, have also led to longer survival times for people diagnosed with cancer (twenty four). CDC conducted a demonstration project on how to provide optimal care to people living in rural areas diagnosed with cancer (twenty five). Although cancer is categorized as a single disease group in this analysis, each cancer site has different risk factors, different treatments, and differences between groups by gender, age, race, and ethnicity. It can manifest itself in different ways. Preventable early deaths may vary by cancer site, and may vary in cancers with increasing prevalence of risk factors (such as obesity), in cancers for which there are no recommended screening methods, or in cancers where treatments have not changed. may not have decreased. Lung cancer is the leading cause of cancer death, accounting for 23% of all cancer deaths in 2020 (20). Geographic differences in combustible tobacco use and access to lung cancer screening may partially account for differences in lung cancer mortality. Access to lung cancer screening facilities is more limited in rural counties than in urban areas (26). Despite an overall decline in preventable early deaths from cancer, early deaths continue to exceed the national average in small metropolitan and non-core counties, highlighting the need to reduce early cancer-related deaths in rural areas. Gender is highlighted. As more urban areas exceeded the 2010 benchmark for cancer mortality rates in 2019, future updates to cancer-specific benchmarks using more recent data will better determine the minimum achievable mortality rates. may be reflected in
unexpected injury
The worsening and growing drug overdose epidemic, the increase in motor vehicle fatalities, and falls are increasing the number of preventable premature deaths from unintentional injuries.27). The narrowing of the rural-urban gap in the rate of preventable premature death due to unintentional injury was due to a worsening of preventable mortality rates in more urban areas, which were lower in metropolitan areas during the study period. It more than doubled in the central area. Regarding drug overdoses, rural counties continue to have limited access to medications to treat opioid use disorder, as evidenced by low buprenorphine dispensing rates and reduced treatment capacity (28). In the case of motor vehicle accidents, rural residents have a higher risk of death and are less likely to wear seatbelts than urban residents (29). Evidence-based interventions reduce rural-urban disparities in seat belt use and motor vehicle fatality rates (30). Many of the risk factors for falls are modifiable, meaning that many falls are preventable (31).
heart disease and stroke
Disparities in preventable premature deaths from heart disease and stroke existed between rural and urban areas throughout the study period. These differences increased from 2019 to June 2022, except for central metropolitan counties, where a 3 percentage point decrease was observed from 2020 to 2021. Increase in preventable premature deaths from heart disease and stroke in 2020 and 2021 likely related to COVID-19 – Associations that contributed to increased risk-related mortality from heart disease and stroke disease (32). When comparing 2020 and 2019, increases in systolic and diastolic blood pressure, the main risk factors for heart disease and stroke, were observed in all age groups (33). Inequalities in the management of hypertension (i.e., systolic blood pressure ≥130 mm Hg, diastolic blood pressure ≥80 mm Hg, or both) have been observed during the COVID-19 pandemic and are inadequate. healthcare access, medication adherence, and monitoring (34). During the height of the COVID-19 pandemic, patients may have delayed or avoided seeking emergency care when experiencing a life-threatening event (35). In the weeks since the novel coronavirus disease (COVID-19) was declared a national emergency on March 13, 2020, emergency room visits for heart attacks and strokes have decreased by 20%, leading to a decline in heart attacks and strokes during the pandemic. and hospitalizations due to stroke also decreased (35). Additionally, COVID-19 infection was associated with an increased risk of stroke and heart disease (36,37).
Chronic lower respiratory disease
Despite an overall decline from 2010 to 2020 (as declines were observed in urban areas), the proportion of preventable premature deaths from CLRD increased from 2010 to 2015 in small and medium urban counties and Rural counties remained relatively stable. From 2010 to 2022, the steepest decline in preventable premature deaths from CLRD in urban areas was from 2019 to 2021, with the decline in deaths from COVID-19 that would otherwise be attributable to CLRD. This may be the result of Patients with CLRD (such as chronic obstructive pulmonary disease) are at increased risk of death from COVID-19 (38).
