Rural Americans at Higher Risk

Sometimes I will take the back roads to work just to see something different from the same old things the work route shows me. While traveling on the back roads, I will go through farm land and see the workers spraying crops. I have seen the crop duster planes in the sky letting their load of pesticides go letting the wind take it where it falls. I have often wondered how healthy the people who live in the line of sprays really are.

The CDC has conducted a new study that demonstrates Americans living in rural areas are more likely to die from five leading causes than their urban counterparts.  Many deaths among rural Americans were potentially preventable in 2014, including 25,000 from heart disease, 19,000 from cancer, 12,000 from unintentional injuries, 11,000 from chronic lower respiratory disease and 4,000 from stroke.  These potentially preventable percentages of deaths were higher in rural areas than in urban areas.  This report is part of a new rural health series in CDC’s Morbidity and Mortality Weekly Report.

According to CDC Director Tom Frieden, M.D., M.P.H. and this new study there is a striking gap in health between the rural and urban areas in America.  He believes we need to work to better understand and address the health threats that put rural Americans at increased risk of early death in order to close this gap.

About 15% of the U.S. population, or about 45 million Americans, are currently living in rural areas.  Some factors that might be putting rural residents at higher risk of death from these public health conditions are demographic, environmental, economic and social factors.  These residents tend to be older and sicker than their urban counterparts and have higher rates of cigarette smoking, high blood pressure and obesity.  They report having less leisure time for physical activity and lower seatbelt usage than their urban counterparts.  Their higher rates of poverty, less access to healthcare and being less likely to have health insurance, is also reported among this group.

The CDC will collaborate with the Health Resources and Services Administration (HRSA) to help promote the findings and recommendations to rural communities.  The past few years has shown an increase in rural-urban disparities in life expectancy and mortality rates.  The National Vital Statistics System was analyzed in the study for the mortality data.

They found about 50% higher unintentional injury deaths in rural areas than in urban, partly due to greater risk of death from motor vehicle crashes and opioid overdoses.  Because of the distance between healthcare facilities and trauma centers, the rapid access to specialized care was more challenging for those in rural areas.

Some of the gaps that can be addressed in rural areas are screening patients for high blood pressure and make control a quality improvement goal, increase cancer prevention and early detection, encourage physical activity and healthy eating, promote smoking cessation, promote motor vehicle safety and engage in safer prescribing of opioids for pain.

Of course, not all deaths can be prevented and some rural areas might have characteristics that put their residents at higher risk of death.  Traveling distances to specialty and emergency care or exposures to specific environment hazards might be some.  The high death rates could also signal a need for improved public health programs that support healthier behaviors and neighborhoods, or better access to health care services.

Dr Fredda Branyon