Figure 1: Age-adjusted death rates among persons of all ages for four out of five leading causes of death in nonmetropolitan and metropolitan area, by year -- National Vital Statistics System, United States, 1999 - 2014.

Rural residents are more likely than metropolitan residents to die prematurely from cancer, respiratory disease, and the other most common causes of death, a Centers for Disease Control report says.

The rate of premature death from unintentional injuries was 50% higher in nonmetropolitan areas from 1999 to 2014, the report said. Premature rural deaths were also more common for all the other leading causes of death, which are chronic respiratory disease, cancer, stroke, and heart disease.

The study calculated age-adjusted “excess death” for metropolitan and nonmetropolitan counties over a 15-year period. Excess deaths are deaths that are over and above what you’d expect to find in a population, based on the age of residents.

The study did not adjust the data to account for other differences between rural and urban residents, such as income levels and race.

The long-term trends showed that in some cases the gap between urban and rural excess death is growing. For example, the age-adjusted death rates from strokes decreased at about the same rate in both metropolitan and nonmetropolitan America. But for heart disease and cancer, the age-adjusted death rate decreased more quickly in cities, meaning the gap between rural and urban death rates expanded during the period of the study.

The death rate for chronic respiratory disease increased for rural America since 1999, while in cities the rate of premature deaths decreased. The most likely cause of that divergence is tobacco use. Rural adults are more likely to be smokers.

Both rural and urban areas saw an increase in unintentional injuries during the study period.

Age-adjusted death rates among persons of all ages for death by stroke in nonmetropolitan and metropolitan area, by year — National Vital Statistics System, United States, 1999 – 2014.

Researchers theorized that the higher rate of opioid abuse in rural America was one cause of the increase in unintentional injury deaths. A lack of access to treatment options and to the drug naxolone, which can reverse opioid overdoses, may be part of the difference between urban and rural overdose rates, researchers said.

Traffic accidents were more likely to lead to death because of higher speed limits and slower transport times to emergency medical services. A general lack of advanced trauma centers and specialists like neurosurgeons, who can treat head injuries, are also a factor, the report said.

Heart disease and stroke were higher due to a combination of behavioral risks like smoking and obesity and barriers to health-care. Rural residents are more likely to lack health insurance and to live in an area that has a shortage of healthcare workers, including specialists.

The study used data from the National Vital Statistics System. “Rural” was defined as counties that are not in a metropolitan statistical area, as determined by the Office of Management and Budget.

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