Rural areas have long been racially and ethnically diverse. Yet most research on rural health focuses on rural-urban disparities without an explicit focus on within-rural differences in health by race and ethnicity. In that research on rural-urban disparities in health, rural residents tend to fare worse on most measures, including mortality, health status, access to care, and use of preventive services. Less is known about whether there are differences in healthcare use among rural residents by race and ethnicity. In this from the University of Minnesota Rural Health Research center, researchers examine differences in preventive care among rural residents by race and ethnicity.  The brief can be accessed here.

Rural residents often travel farther to access medical care, especially obstetric care, and are more likely to be uninsured or underinsured than urban residents, contributing to higher rates of maternal morbidity. To raise awareness and increase understanding of the relationship between transfer, delivery hospital location, and severe maternal morbidity and mortality (SMMM) for rural residents, researchers at the University of Minnesota Rural Health Research Center compared data for rural and urban residents who gave birth between 2008 and 2014, to describe the relationship between a need to transfer patients for specialized care and increased risk for maternal morbidity and mortality.  The report can be accessed here.

The Centers for Disease Control and Prevention (CDC) recently released two reports that compare health issues between metropolitan and nonmetropolitan areas of the U.S.  In Potentially Excess Deaths from the Five Leading Causes of Death, researchers found that the gap in the percentages of preventable deaths between rural and urban counties widened over the eight-year study period for cancer, heart disease, and chronic lower respiratory disease, remained relatively stable for stroke, and decreased for unintentional injuries.  A study on Lung Cancer Incidence found that rates decreased in both urban and rural areas during the ten year period from 2007-2016, but the smallest decrease occurred among females living in nonmetropolitan counties.  Click here to access the report.

Large, brand-name drugmakers could lose $1 trillion in sales and remain profitable enough to maintain their current investments in research and development, according to a report released last week by West Health and Johns Hopkins Bloomberg School of Public Health. Sean Dickson, director of health policy at the West Health Policy Center and the lead author of the analysis, said the findings suggest drug pricing regulations would not substantially harm the industry. (Source: Healthcare Finance News, 11/14)

The Appalachian Regional Commission (ARC) released Industrial Make-Up of the Appalachian Region, a new report examining employment and earnings across the Region. Drawing on data from 15 industry sectors, the report catalogs how the Region’s industrial make-up and earnings compare to that of the country as a whole. The report primarily focuses on the period from 2002–2017 — the years immediately before, during, and after the Great Recession – and finds that employment growth varies across the Region. Overall, while post-Recession employment growth has been positive in Appalachia, it lags behind the growth that was experienced by the country as a whole. The report also finds an overall employment shift across the Region towards professional & technical services; health & social services; and tourism-related jobs.

Among the Report’s key findings: from 2012 to 2017, employment across all industries in Appalachia grew 4.7 percent. While growth was positive, employment nationwide grew 9.6 percent during the same time period. From 2012 to 2017, the fastest growth in employment occurred in Appalachia’s South Central and Southern subregions, at 6.6 percent and 10.4 percent, respectively. In 2017, the five industries with the largest employment shares in the Region were professional & technical services (12.1 percent), health and social services (11.6 percent), retail and trade (11.1 percent); state and local government (11.1 percent); and manufacturing (10 percent). In 2017, 10 percent of Appalachia’s total employment was in the manufacturing industry, a larger share than the country as a whole (6.8 percent).

Abstract

Problem/Condition: A 2017 report quantified the higher percentage of potentially excess (or preventable) deaths in nonmetropolitan areas (often referred to as rural areas) compared with metropolitan areas. In that report, CDC compared national, regional, and state estimates of potentially excess deaths among the five leading causes of death in nonmetropolitan and metropolitan counties for 2010 and 2014. This report enhances the geographic detail by using the six levels of the 2013 National Center for Health Statistics (NCHS) urban-rural classification scheme for counties and extending estimates of potentially excess deaths by annual percent change (APC) and for additional years (2010–2017). Trends were tested both with linear and quadratic terms.

Period Covered: 2010–2017.

Description of System: Mortality data for U.S. residents from the National Vital Statistics System were used to calculate potentially excess deaths from the five leading causes of death among persons aged <80 years. CDC’s NCHS urban-rural classification scheme for counties was used to categorize the deaths according to the urban-rural county classification level of the decedent’s county of residence (1: large central metropolitan [most urban], 2: large fringe metropolitan, 3: medium metropolitan, 4: small metropolitan, 5: micropolitan, and 6: noncore [most rural]). Potentially excess deaths were defined as deaths among persons aged <80 years that exceeded the number expected if the death rates for each cause in all states were equivalent to those in the benchmark states (i.e., the three states with the lowest rates). Potentially excess deaths were calculated separately for the six urban-rural county categories nationally, the 10 U.S. Department of Health and Human Services public health regions, and the 50 states and District of Columbia.

Results: The number of potentially excess deaths among persons aged <80 years in the United States increased during 2010–2017 for unintentional injuries (APC: 11.2%), decreased for cancer (APC: −9.1%), and remained stable for heart disease (APC: 1.1%), chronic lower respiratory disease (CLRD) (APC: 1.7%), and stroke (APC: 0.3). Across the United States, percentages of potentially excess deaths from the five leading causes were higher in nonmetropolitan counties in all years during 2010–2017. When assessed by the six urban-rural county classifications, percentages of potentially excess deaths in the most rural counties (noncore) were consistently higher than in the most urban counties (large central metropolitan) for the study period. Potentially excess deaths from heart disease increased most in micropolitan counties (APC: 2.5%) and decreased most in large fringe metropolitan counties (APC: −1.1%). Potentially excess deaths from cancer decreased in all county categories, with the largest decreases in large central metropolitan (APC: −16.1%) and large fringe metropolitan (APC: −15.1%) counties. In all county categories, potentially excess deaths from the five leading causes increased, with the largest increases occurring in large central metropolitan (APC: 18.3%), large fringe metropolitan (APC: 17.1%), and medium metropolitan (APC: 11.1%) counties. Potentially excess deaths from CLRD decreased most in large central metropolitan counties (APC: −5.6%) and increased most in micropolitan (APC: 3.7%) and noncore (APC: 3.6%) counties. In all county categories, potentially excess deaths from stroke exhibited a quadratic trend (i.e., decreased then increased), except in micropolitan counties, where no change occurred. Percentages of potentially excess deaths also differed among and within public health regions and across states by urban-rural county classification during 2010–2017.

Interpretation: Nonmetropolitan counties had higher percentages of potentially excess deaths from the five leading causes than metropolitan counties during 2010–2017 nationwide, across public health regions, and in the majority of states. The gap between the most rural and most urban counties for potentially excess deaths increased during 2010–2017 for three causes of death (cancer, heart disease, and CLRD), decreased for unintentional injury, and remained relatively stable for stroke. Urban and suburban counties (large central metropolitan and large fringe metropolitan, medium metropolitan, and small metropolitan) experienced increases in potentially excess deaths from unintentional injury during 2010–2017, leading to a narrower gap between the already high (approximately 55%) percentage of excess deaths in noncore and micropolitan counties.

Public Health Action: Routine tracking of potentially excess deaths by urban-rural county classification might help public health departments and decision-makers identify and monitor public health problems and focus interventions to reduce potentially excess deaths in these areas.

Read the full report here: https://www.cdc.gov/mmwr/volumes/68/ss/ss6810a1.htm

Mental Health America has released their state by state report on mental health care. Pennsylvania is ranked number one in the nation in State of Mental Health in America. The access measures include access to insurance, access to treatment, quality and cost of insurance, access to special education, and workforce availability. A high access ranking indicates that a state provides relatively more access to insurance and mental health treatment.

Traumatic childhood experiences are associated with higher odds of developing some of the leading causes of death later in life, according to a CDC report published this week. Overall, CDC estimated that eliminating childhood trauma could prevent 1.9 million cases of coronary heart disease, 2.5 million cases of obesity, and 21 million cases of depression. (Source: Associated Press, 11/5)