Discussion
Rural residents, particularly those in noncore counties, have experienced alarming percentages of preventable premature deaths. While these disparities are often associated with place of residence, it is important to note that they are not limited to geographical location. Demographic factors such as sex, race, and ethnicity also play a significant role in the disparities of all-cause premature deaths.
In rural counties where a majority of the population consists of Black, African American, American Indian, or Alaska Native individuals, the rates of premature deaths are especially high. To address these disparities and develop effective interventions and healthcare policies, it is crucial to gather data on cause-specific premature deaths from the five leading causes, considering factors like rural-urban county categories, race, and ethnicity.
Cancer
The progress made in reducing preventable premature deaths from cancer has been significant, particularly in urban counties where access to preventive services, treatment, and specialty care is more readily available. Large central and fringe metropolitan areas have achieved benchmark rates, consistent with the overall decline in cancer mortality over the past two decades. Increased screening for leading causes of cancer deaths, such as lung, colon, cervical, and female breast cancers, has resulted in earlier detection and more effective treatment. Additionally, vaccination rates for cancer-causing viruses have risen, and the prevalence of risk factors like combustible tobacco use has decreased. The expansion of Medicaid has improved access to cancer prevention and early detection strategies. Furthermore, advancements in cancer treatments, particularly for lung cancer and melanoma, have increased the survival rates for those diagnosed with these types of cancer. It is important to note that different cancer sites have distinct risk factors, treatment methods, and manifestations among various groups based on sex, age, race, and ethnicity. Therefore, it is essential to consider specific cancer sites when evaluating preventable premature deaths, as certain cancers might not have experienced a decrease in mortality due to factors like increasing prevalence of risk factors, lack of recommended screening modalities, or unchanged therapies. Notably, lung cancer remains the leading cause of cancer mortality, accounting for a significant portion of overall cancer deaths. Geographic differences in combustible tobacco use and access to lung cancer screening facilities contribute to disparities in lung cancer mortality, with rural counties facing greater challenges in these areas. Addressing the disparities in cancer-related premature deaths in rural areas is crucial, as despite overall reductions in preventable premature deaths from cancer, rural areas still have rates that exceed the national average.
Unintentional Injury
The prevalence of preventable premature deaths from unintentional injury has been increasing due to various factors such as the drug overdose epidemic, motor vehicle traffic fatalities, and falls. Rural-urban disparities have narrowed, with worsening rates in more urban areas leading the trend. Access to medications for opioid use disorder remains limited in rural counties, indicated by low buprenorphine dispensing rates and reduced treatment capacity. Moreover, rural residents face an increased risk of death in motor vehicle traffic crashes and are less likely to wear seat belts compared to their urban counterparts. Evidence-based interventions, particularly focusing on seat belt use, have proven effective in reducing rural-urban disparities in motor vehicle death rates. Many fall risk factors are also modifiable, offering opportunities for prevention. Collectively, addressing these causes of unintentional injury-related deaths requires comprehensive strategies targeting both rural and urban areas.
Heart Disease and Stroke
Disparities in preventable premature deaths from heart disease and stroke persist between rural and urban areas. These disparities have further widened in recent years, excluding large central metropolitan counties, where a slight decrease was observed. The increases in these deaths can be attributed to COVID-19-related conditions that have contributed to higher mortality rates from heart disease and stroke. The pandemic has resulted in increases in systolic and diastolic blood pressure, a primary risk factor for these conditions, across all age groups. Inadequate access to healthcare, medication adherence, and monitoring has led to inequities in the control of hypertension during the pandemic. Delayed or avoided emergency care during the height of the COVID-19 crisis has also impacted these mortality rates. Furthermore, COVID-19 itself has been associated with an increased risk of stroke and heart disease. These findings underscore the need for comprehensive interventions to address the underlying risk factors, improve healthcare access, and enhance emergency response systems for heart disease and stroke patients.
Chronic Lower Respiratory Disease
While there has been an overall decrease in preventable premature deaths from Chronic Lower Respiratory Disease (CLRD) due to improvements observed in larger urban areas, the percentage of such deaths has remained relatively stable in medium and small urban counties as well as rural counties during the study period. However, a pronounced decline in preventable premature deaths from CLRD occurred in urban areas from 2019 to 2021. This decline can partly be attributed to a potential shift in causes of death from CLRD to COVID-19. Individuals with CLRD, including chronic obstructive pulmonary disease (COPD), are at an increased risk of death from COVID-19. While this decline is promising, concerted efforts are needed to further reduce preventable premature deaths from CLRD in both urban and rural areas.
Implications and Future Trends
The findings highlighted in this analysis shed light on the critical need for targeted interventions to address rural-urban disparities in preventable premature deaths. While progress has been made in reducing premature deaths from certain causes like cancer, challenges persist, particularly in rural areas. This calls for comprehensive strategies aimed at improving healthcare access, promoting preventive services, and reducing risk factors.
The COVID-19 pandemic has further exacerbated disparities in preventable premature deaths. The impact of COVID-19 on heart disease, stroke, and CLRD mortality rates underscores the importance of preparedness and timely healthcare interventions during public health emergencies. Strengthening healthcare infrastructure, promoting telehealth services, and enhancing public health campaigns are crucial steps towards mitigating the impact of future pandemics on premature deaths.
Moving forward, emerging trends and technologies offer promising avenues for addressing preventable premature deaths. Advances in telemedicine can improve access to healthcare services in rural areas, allowing for more timely interventions and regular monitoring of high-risk populations. Robust data collection and analysis can help identify underlying causes and implement targeted interventions in specific geographical regions. Furthermore, partnerships between healthcare providers, community organizations, and policymakers are essential in developing comprehensive strategies that tackle the root causes of premature deaths.
Taking a proactive approach, policymakers should prioritize investments in public health infrastructure, including prevention programs, research, and healthcare delivery systems. Continuous monitoring and evaluation of interventions should be conducted to ensure their effectiveness and guide further improvements. Additionally, addressing social determinants of health, such as income inequality, education, and housing, can contribute to reducing disparities in preventable premature deaths.
In conclusion, the analysis presented in this article highlights the persistent disparities in preventable premature deaths between rural and urban areas. While progress has been made in certain areas, challenges remain, necessitating comprehensive strategies to address the underlying causes. The COVID-19 pandemic has further highlighted the need for preparedness, healthcare access, and targeted interventions. Future trends and emerging technologies offer potential solutions, while a holistic approach encompassing healthcare, community engagement, and policy interventions is crucial in reducing premature deaths and promoting equitable health outcomes for all.
