A new study released in the CDC’s Morbidity and Mortality Weekly Report (MMWR) shows the gap in preventable premature mortality (or early death) between rural and urban America is growing wider. People living in rural areas are at a higher risk of dying early from one of the five leading causes of death when the death could have been prevented compared to people living in urban areas.  A video on premature and preventable deaths is available here.

This report is an extension of the 2019 CDC study, which showed the percentage of preventable early deaths from the five leading causes was higher in rural counties compared with urban counties during 2010–2017. It extends the study period by including mortality data for additional years (2018-2022), expanding the analysis from 2010 to 2022. Below are some of the main findings, and a brief data visualization of the report is available here.

Cancer 

• The percentage of preventable early cancer deaths among all premature deaths declined from 21% in 2010 to 0.3% in 2022. Regardless of metropolitan status, all county categories experienced declines.
• However, declines in urban areas were larger than those in rural areas, which widened the rural-urban disparities in early cancer deaths.
• Differences in tobacco use and less access to lung cancer screening facilities may explain some of this gap.

Unintentional injury

• The percentage of preventable early deaths from unintentional injury increased from 2010 through 2019 (39% to 54%), followed by a steep increase from 2019 to 2021 and a slight decrease through June 2022 to 64%.
• Increases in the percentage of preventable early deaths from unintentional injury during 2010-2022 were statistically significant for all rural-urban county categories except micropolitan (rural counties with small towns, population of 10,000 to 50,000 person).
• Percentages were higher in rural areas than in urban areas, but the gap narrowed.
• The worsening and expanding drug overdose epidemic, increases in motor vehicle traffic fatalities, and increases in falls drive the growth in early deaths from unintentional injury.

Stroke

• The percentage of preventable early deaths from stroke declined slightly from 2010 through 2019 (32% to 26%), followed by an increase to 34% through June 2022.
• Each rural-urban county category experienced steep increases from 2019 to June 2022, except for the most rural counties, which experienced a slight decrease from 2021 to June 2022; rural counties had the highest percentage from January to June 2022 (42% in micropolitan counties and 41% in noncore counties).
• Increases in 2020 and 2021 were likely associated with COVID-19-related conditions that contributed to risk-associated increased heart disease and stroke mortality, such as delayed or avoided emergency care treatment.
• The highest percentages of preventable early deaths from stroke in 2022 were in southern states.

These findings can help guide local public health interventions to reduce risks of early death, while also highlighting the need to understand and address underlying social, environmental, and structural inequities contributing to disparities in preventable early deaths between rural and urban areas.

Access the full report and share this information with your network using our partner toolkit. This resource contains social media messages, graphics, and newsletter text you can use to help bring awareness of these findings and the need for more multi-sector approaches and focused interventions across the U.S. to reduce early death from the five leading causes. View CDC’s rural health website and  Rural Public Health At-a-Glance to find out what CDC is doing to improve the health and well-being of rural communities.

For as long as statistics about opioid overdose deaths have been collected in the United States, white individuals have been much more likely to die than Black individuals of the same age. With the rapidly increasing rate of fentanyl overdoses in the late 2010s, that trend began to reverse — by the start of the COVID-19 pandemic in 2020, more Black Americans began to die of opioid overdoses and from drug overdoses of any kind, according to researchers at Penn State.

New research from the Penn State College of Health and Human Development examined racial and regional differences in overdose fatalities from 2012-21, capturing the periods preceding and during the COVID-19 pandemic. In most of the nation, the researchers found that younger Black individuals died of overdose at lower rates than their white counterparts, but older Black individuals — especially men in Midwestern cities — became several times more likely to die of drug overdose than their white counterparts as the COVID-19 pandemic emerged.

The study was published in The American Journal on Addictions.

Read more.

This brief explores the current trend in hospital affiliation from a rural perspective and offers guidance to rural hospital leaders in navigating a potential affiliation. With an understanding of the rural context and challenges facing rural hospitals, risks and opportunities across key areas for consideration are presented, including costs, quality, service delivery and system finances. The brief offers an overview of the affiliation process and how to assess success.

Rural hospitals are anchor institutions in their communities and are the hubs for a host of healthcare services such as emergency care, outpatient care, long term care, and primary care in provider-based rural health clinics. However, rural hospitals are affected by an amalgam of factors which may lead them to consider alternative organizational structures such as participating in local rural health networks and affiliating with large regional health systems.

Read the full report.

Principal Authors: Joel M. James, MPH, Guest Author and Keith J. Mueller, PhD, Chair
Contributing Author: Dan M. Shane, PhD
Prepared by the RUPRI Health Panel: Alva O. Ferdinand, DrPh, JD; Alana D. Knudson, PhD; Jennifer P, Lundblad, PhD, MBA; A. Clinton MacKinney, MD, MS; and Timothy D. McBride, PhD

This work was supported by the Leona M. and Harry B. Helmsley Charitable Trust.

Researchers at the University of Minnesota Rural Health Research Center used data on hospital ransomware attacks from 2016 to 2021, describing disrupted operations at hospitals in rural and urban areas.

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The Economic Research Service (ERS) at the U.S. Department of Agriculture analyzed natural-cause mortality data for adults aged 25-54 from two three-year periods – 1999 through 2001 and 2017 through 2019.  Researchers found that the mortality rate from natural causes such as chronic disease and cancer in rural areas was only 6 percent higher than for city dwellers during the first period, but the gap widened to 43 percent by 2019.

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This policy brief used American Hospital Association (AHA) survey data to examine partnerships between hospitals and external organizations to address social needs. Hospitals were stratified by rurality (metropolitan or non-metropolitan) and type—prospective payment system (PPS) or critical access hospital (CAH) as well as by region, ownership status and accountable care organization (ACO) participation. We calculated a partnership score for all hospitals reflective of the number of types of partnerships and the number of ways that hospital partner to address social needs with scores ranging from 0 to 48. We also assessed what types of specific partnerships hospitals indicated.  Key findings are noted below:

• The highest mean community partnership scores were seen in metropolitan PPS hospitals (24.0), followed by non-metropolitan PPS hospitals (20.4) and CAHs (16.8).
• Except for non-metropolitan PPS hospitals in the West, the Northeast had the highest mean partnerships across hospital types.
• Regardless of geography or type (CAH or PPS), non-profit hospitals and those participating in ACOs had higher mean partnership scores.

Most hospitals had partnerships with state and local agencies, though compared to other types of hospitals, a higher proportion of metropolitan PPS hospitals had partnerships with organizations that address specific social needs (e.g., food insecurity).

Authors:  Whitney E. Zahnd, PhD; Khyathi Gadag, MHA; Kristin D. Wilson, PhD, MHA; Keith J. Mueller, PhD

Contact Information: Lead Author: Whitney Zahnd, PhD; whitney-zahnd@uiowa.edu

In this brief from the University of Minnesota Rural Health Research center, respondents from advocacy and support organizations identified challenges faced by rural victims across six themes: 1) lack of access to IPV related support services and health care, 2) knowledge and competency limitations among professionals providing services to IPV victims, 3) insufficient resources to meet basic needs, 4) harmful attitudes and norms, 5) detrimental policies and systems, and 6) intersecting risks for IPV victims who belong to marginalized or at-risk groups (e.g., those who are pregnant/postpartum, immigrants, BIPOC [Black, Indigenous, and People of Color], and/or LGBTQ+ [lesbian, gay, bisexual, transgender, queer/questioning]).

Read the full report here.

In a study funded by the National Institutes of Health, researchers examined how expansions for state Medicaid for American Indian/Alaska Native (AI/AN) women were associated with health insurance, prenatal care, health conditions, and birth outcomes. They found Medicaid expansions increased the proportion of AI/AN women reporting healthcare coverage, had no effects on the first-trimester prenatal care usage or birthweight of AI/AN women, and mixed evidence of increased rates of pre-pregnancy chronic conditions after expansions.

Read the full report here.

The RUPRI Center for Rural Health Policy Analysis Explores the extent to which hospitals partner with community organizations to address population and/or community health needs.

Read the full article here.

Researchers at the Rural and Minority Health Research Center assess the availability of in-county diabetes self-management education and dialysis across rural and urban counties.

Read the full report here.