Preventable Premature Deaths from the Five Leading Causes of Death in Nonmetropolitan and Metropolitan Counties, United States, 2010–2022

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Preventable ********** Deaths from the Five Leading Causes of ****** in Nonmetropolitan and Metropolitan Counties, ******* States, 2010–2022

Discussion

Rural residents, particularly those in noncore counties, experienced high percentages of preventable ********** deaths during the study *******. The rural-urban disparities in ********** deaths varied by cause of ******. However, disparities were not limited to place of residence. Disparities in all-cause ********** deaths also were associated with other demographic factors (e.g., ****, race, and ethnicity) (11). For example, the highest rates of ********** deaths were observed in rural counties where a majority of the population was ******, ******** *********, ********* Indian, or Alaska Native (11). To address disparities in preventable ********** deaths across rural and urban counties, data on disparities in cause-specific ********** deaths from the five leading causes by rural-urban county category, race, and ethnicity are needed to inform interventions and health care policies for specific ******* and ******* groups. A follow-up of this analysis stratified by race and ethnicity will be published in subsequent reports, further contributing evidence to guide existing and new programs and policies.

*******

Overall, the decrease in preventable ********** deaths from ******* was substantial and was greatest in urban counties where access to preventive services, treatment, survivor care, and specialty care is much higher than in rural counties (19). Large central metropolitan and fringe metropolitan areas achieved the benchmark rates in 2019. This is consistent with overall declines in ******* mortality, which decreased 27% between 2001 and 2020 (20). The decrease in preventable ********** deaths likely reflects multiple factors. Increases in recommended screening for the leading causes of deaths from ******* (e.g., lung, colon, cervical, and female *******) have led to earlier detection, when treatment is more effective, and prevention by detecting cellular changes before they turn into *******, as in the case of colorectal ******* (21). Increases in vaccination rates for *******-causing viruses and decreases in prevalence of risk factors (e.g., combustible tobacco use) also have driven ******* mortality downward (22). Access to these ******* prevention and early detection strategies was increased with the expansion of Medicaid (23). New ******* treatments and therapies, specifically for lung ******* and melanoma, also have led to longer survival for those with a ******* diagnosis (24). CDC conducted a demonstration project on how to best provide care for persons living in rural areas who had ******* diagnosed (25). Although ******* is categorized as a single ******** group in this analysis, each ******* site has different risk factors, has varying treatment methods, and can manifest itself in different ways among groups by ****, age, race, and ethnicity. Preventable ********** ****** might vary depending on the ******* site and might not have decreased for cancers with increasing prevalence of risk factors (e.g., obesity), no recommended screening modalities, or therapies that have not changed. Lung *******, the leading cause of ******* mortality, accounted for 23% of all ******* deaths in 2020 (20). Geographic differences in combustible tobacco use and use of lung ******* screening likely partially drive differences in lung ******* mortality. Access to lung ******* screening facilities is more limited in rural counties than in urban counties (26). Despite overall reductions in preventable ********** deaths from *******, ********** deaths surpass the national average in micropolitan and noncore counties, highlighting the need in rural areas to reduce *******-related ********** deaths. Because more urban areas surpassed the 2010 benchmarks for ******* ****** rates in 2019, future updates to the *******-specific benchmarks using more recent years of data might better reflect the lowest achievable ****** rates.

Unintentional Injury

The worsening and expanding ***** overdose epidemic, increases in motor vehicle traffic fatalities, and falls drive the growth in preventable ********** deaths from unintentional injury (27). Narrowing rural-urban disparities in the percentage of preventable ********** deaths from unintentional injury were driven by worsening rates of preventable mortality in more urban areas, with the percentage more than doubling in large central metropolitan areas over the study *******. For ***** overdoses, access to medications for opioid use disorder continues to be more limited in rural counties, as evidenced by low buprenorphine dispensing rates and reduced treatment capacity (28). For motor vehicle traffic crashes, rural residents have an increased risk for ****** and are less likely than urban residents to wear seat belts (29). Evidence-based interventions reduce rural-urban disparities in seat belt use and motor vehicle ****** rates (30). Many fall risk factors are modifiable, implying that many falls can be prevented (31).

Heart ******** and *******

Disparities in preventable ********** deaths from heart ******** and ******* between rural and urban areas existed across the study *******. These gaps increased from 2019 to June 2022, except in large central metropolitan counties where a decrease of three percentage points was observed from 2020 to 2021. Increases in preventable ********** deaths from heart ******** and ******* in 2020 and 2021 were likely associated with COVID-19–related conditions that contributed to risk-associated increased mortality from heart ******** and ******* (32). Increases in systolic and diastolic blood pressure, a leading risk factor for heart ******** and *******, were observed among all age groups when comparing 2020 with 2019 (33). Inequities in control of hypertension (i.e., systolic blood pressure values of ≥130 mm Hg, diastolic blood pressure of >80 mm Hg, or both) were observed during the COVID-19 pandemic and are related to insufficient health care access, medication adherence, and monitoring (34). Patients might have delayed or avoided seeking emergency care when experiencing a life-threatening event during the height of the COVID-19 pandemic (35). Emergency department visits for heart ******* and ******* decreased by 20% during the weeks after the declaration of COVID-19 as a national emergency on March 13, 2020, and hospital admissions for heart ******* and ******* decreased during the pandemic (35). In addition, COVID-19 was associated with an increased risk for ******* and heart ******** (36,37).

Chronic Lower Respiratory ********

Despite the overall decrease during 2010–2020 (because of decreases observed in larger urban areas), the percentage of preventable ********** deaths from CLRD was relatively stable in medium and small urban counties and rural counties during 2010–2015. During 2010–2022, the sharpest decline in preventable ********** ****** from CLRD in urban areas occurred from 2019 through 2021 and could be the result of deaths from COVID-19 that otherwise would have been attributable to CLRD. Persons with CLRD (e.g., chronic obstructive pulmonary ********) are at increased risk for ****** from COVID-19 (38).

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