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


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


Overall, the decline in preventable premature deaths from cancer has been substantial and greatest in urban counties where access to preventive services, treatments, survivorship care, and specialty care is much higher than in urban counties. rural counties (19). Large central and peripheral metropolitan areas reached benchmark rates in 2019. This is consistent with the overall decline in cancer mortality, which fell by 27% between 2001 and 2020 (20). The decline in preventable premature deaths likely reflects several factors. Increased recommended screening for the leading causes of cancer death (e.g., lung, colon, cervix, and breast in women) has led to earlier detection, when treatment is more effective, and to prevention by detecting cellular changes before they turn into cancer, such as in colorectal cancer (21). Increasing rates of vaccination against carcinogenic viruses and decreasing prevalence of risk factors (e.g., combustible smoking) have also decreased cancer mortality (22). Access to these cancer prevention and early detection strategies has been increased with the expansion of Medicaid (23). New cancer treatments and therapies, particularly for lung cancer and melanoma, have also led to longer survival for people diagnosed with cancer (24). The CDC conducted a demonstration project on how to best provide care to people living in rural areas who have been diagnosed with cancer (25). Although cancer is classified as a single disease group in this analysis, each cancer site has different risk factors, different treatment methods, and may manifest in different ways in different groups depending on gender, age, race and ethnicity. Preventable premature deaths may vary by cancer site and may not have declined for cancers with increasing prevalence of risk factors (e.g., obesity), no recommended screening modality, or therapies that have no not changed. Lung cancer, the leading cause of cancer mortality, accounted for 23% of all cancer deaths in 2020 (20). Geographic differences in combustible tobacco use and uptake of lung cancer screening likely partly explain differences in lung cancer mortality. Access to lung cancer screening facilities is more limited in rural counties than in urban counties (26). Despite the overall reduction in preventable premature deaths from cancer, premature deaths exceed the national average in micropolitan and non-core counties, highlighting the need in rural areas to reduce premature cancer-related deaths. As more urban areas exceeded the 2010 benchmark cancer death rates in 2019, future updates of cancer-specific benchmarks using more recent years of data may better reflect rates. mortality rates as low as possible.

Unintentional injury

The worsening and expanding epidemic of drug overdoses, increased traffic fatalities and falls are leading to an increase in preventable premature deaths from unintentional injuries (27). The reduction in rural-urban disparities in the percentage of preventable premature deaths from unintentional injuries was due to worsening preventable mortality rates in more urban areas, with the percentage more than doubling in large metropolitan areas central during the study period. For drug overdoses, access to opioid use disorder medications continues to be more limited in rural counties, as evidenced by low buprenorphine dispensation rates and reduced treatment capacity (28). In traffic accidents, rural residents are at increased risk of death and are less likely than urban residents to wear seat belts (29). Evidence-based interventions reduce rural-urban disparities in seat belt use and automobile fatality rates (30). Many fall risk factors are modifiable, meaning that many falls can be prevented (31).

Heart disease and stroke

Disparities in preventable premature deaths from heart disease and stroke between rural and urban areas existed throughout the study period. These gaps widened from 2019 to June 2022, except in large central metropolitan counties where a three percentage point decrease was observed from 2020 to 2021. The increase in preventable premature deaths from heart disease and accidents stroke in 2020 and 2021 was likely associated with COVID-19. –related conditions that contributed to increased mortality associated with heart disease and stroke risk (32). Increases in systolic and diastolic blood pressure, one of the main risk factors for heart disease and stroke, were observed in all age groups comparing 2020 to 2019 (33). Inequalities in hypertension control (i.e., systolic blood pressure values ​​≥130 mm Hg, diastolic blood pressure >80 mm Hg, or both) have been observed during the COVID-19 pandemic and are linked to insufficient access to health care, therapeutic compliance, and monitoring (34). Patients may have delayed or avoided seeking emergency care when they experienced a life-threatening event during the height of the COVID-19 pandemic (35). Emergency room visits for heart attacks and strokes decreased by 20% in the weeks after COVID-19 was declared a national emergency on March 13, 2020, and hospitalizations for heart attacks and strokes decreased during the pandemic (35). Additionally, COVID-19 was associated with an increased risk of stroke and heart disease (36,37).

Chronic lower respiratory tract disease

Despite the overall decrease during the 2010-2020 period (due to decreases observed in large urban areas), the percentage of preventable premature deaths due to CLRD was relatively stable in medium and small urban counties and rural counties during from the period 2010-2015. Over the 2010-2022 period, the largest decline in preventable premature deaths from CLRD in urban areas occurred between 2019 and 2021 and may be the result of COVID-19 deaths that otherwise would have been attributable to CLRD. People with CLRD (eg, chronic obstructive pulmonary disease) are at increased risk of death from COVID-19 (38).

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