Preventable Deaths More Common in
Rural America

Megan Brooks

November 07, 2019

Potentially preventable deaths from the five leading causes of death — cancer, heart disease, unintentional injury, chronic lower respiratory disease (CLRD) and stroke — happen more often among residents living in the most rural areas of the United States than among their urban-dwelling peers, according to new federal data.

"We are encouraged to find that preventable deaths from cancer have gone down overall, yet there is a persistent and striking gap between rural and urban Americans for this and other leading causes of death," Robert R. Redfield, MD, director of the Centers for Disease Control and Prevention (CDC), said in a news release.

"There are proven strategies for reducing health risks like cigarette smoking and obesity, and we need to redouble our prevention efforts to reach those living in rural areas, where risks tend to be higher," Redfield said.

Macarena Garcia, DrPH, with the Center for Surveillance, Epidemiology, and Laboratory Services, and colleagues published their findings today in the CDC's Morbidity and Mortality Weekly Report.

The researchers analyzed mortality data from 2010 to 2017 from the National Vital Statistics System to calculate potentially preventable deaths for the five leading causes of death among people younger than age 80 years. 

In contrast to prior studies that looked at only two categories of counties — urban or rural — the current study breaks counties down further into six categories: large central metropolitan (the most urban), large fringe metropolitan, medium metropolitan, small metropolitan, micropolitan, and noncore (the most rural).

The data reveal a widening gap in the percentage of preventable deaths between rural and urban counties for deaths from cancer, heart disease, and CLRD. The rural/urban gap was relatively stable for stroke and decreased for unintentional injuries. However, the decrease in the gap for preventable deaths from unintentional injuries wasn't the result of decreases in rural counties but instead was a result of the sharp rise in urban areas, in large part because of the opioid crisis, the authors note.

Percentages of preventable deaths were generally higher in the southeastern US for most causes than in other regions.

Specifically, the data reveal the following changes:

Table. Percentage of potentially excess deaths among persons aged <80 years from the five leading causes of death, by urban-rural county classification

Cause of Death




Most rural (%)

Most urban (%)

Most rural (%)

Most urban (%)






Heart disease





Unintentional injury

















Targeted Prevention Strategies

According to the CDC, more than 46 million Americans live in rural areas. Compared with their urban residents, rural residents tend to be older and sicker than those living in urban areas. Rural residents are also more likely to smoke cigarettes and have hypertension and obesity, be less physically active and not use seatbelts. They also have higher rates of poverty, less access to healthcare, and are less likely to have health insurance.

To help reduce the burden of preventable deaths among rural Americans, the CDC asks rural healthcare providers and public health departments to screen patients for hypertension and make blood-pressure control a quality improvement goal; increase cancer prevention and early detection efforts and promote smoking cessation; encourage physical activity and healthy eating; promote motor vehicle safety; and engage in safer prescribing of opioids for pain.

MMWR. Published online November 7, 2019. Full text

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