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)

The United States has seen decreases in life expectancy and increases in obesity and drug overdose rates, as well as steadily increasing overall health care costs, according to a recent report from CDC’s National Center for Health Statistics that spotlights the state of health in the country. For example, the report found that average life expectancy at birth decreased to 78.6 years in 2017, from 78.7 years in 2016. (Source: Axios‘ “Vitals,” 10/30)

With November being National Diabetes Awareness Month and Americans collectively spending nearly $200 billion per year on obesity-related health costs, the personal-finance website WalletHub released its report on 2019’s Fattest States in America as well as accompanying videos, along with interesting stats about diabetes in its Facts & Statistics infographic.

To determine which states contribute the most to America’s overweight and obesity problem, WalletHub compared the 50 states and the District of Columbia across 29 key metrics. They range from share of overweight and obese population to sugary-beverage consumption among adolescents to obesity-related health care costs.

Young adults aged 18-29 years old who live in rural areas and self-report injection drug use are at risk for hepatitis C virus (HCV) infection.  Researchers in New Mexico identified gaps in knowledge about risk and prevention, screening, treatment, and reinfection as a source of this risk and highlight the importance of risk reduction counseling by frontline public health providers.  The study was published earlier this year and is now available in the library of the National Institutes of Health.  Click here for the full report.

A report from the RAND Corporation “describes a basic, multi-level framework for mapping the system of factors and mechanisms that most influence positive and negative outcomes in rural communities.”  Researchers sought to go beyond data and statistics on national trends and investigate variables at the local level.  The RAND Corporation is a nonprofit, nonpartisan organization researching solutions to public policy challenges.

The opportunity to prosper begins with preventive health care when children are young. A healthy start includes immunizations, screenings, regular dental care, well-child visits and access to nutritious food.  However, 124,000 Pennsylvania children do not have health insurance, and children under six are the most likely to be without coverage according to our newest report, “State of Children’s Health Care in Pennsylvania: Powering Up Healthy Kids.”

While Pennsylvania’s uninsured rate falls below the national average, it remains stagnant at 4.4 percent, with Pennsylvania ranking in the middle of the pack at 24th for the percentage of uninsured children.

According to a new report released by the Georgetown University Center for Children and Families, the number of uninsured children increased nationally by more than 400,000 between 2016 and 2018, reversing a long-standing positive trend.

No child should be without health care insurance and our report sets a clear agenda to strengthen both access and coverage benefits in health care for the Commonwealth’s children.

Access the full report here.