QuickStats: Percentage of Adults Aged ≥18 Years with Diagnosed Heart Disease, by Urbanization Level and Age Group — National Health Interview Survey, United States, 2020

June 10, 2022

In 2020, 6.3% percent of adults aged ≥18 years had diagnosed heart disease.

The prevalence of heart disease among adults aged ≥18 years was higher among those living in nonmetropolitan areas (8.8%) compared with those living in metropolitan areas (5.8%).

Prevalence increased with age from 0.9% among adults aged 18–44 years to 5.9% among those aged 45–64 years and 18.2% among those aged ≥65 years.

Among adults aged 45–64 years, those living in nonmetropolitan areas (7.8%) were more likely to have heart disease than those living in metropolitan areas (5.6%).

There was no statistically significant difference by urbanization level for adults aged 18–44 or ≥65 years.

Source: National Center for Health Statistics, National Health Interview Survey, 2020. https://www.cdc.gov/nchs/nhis.htm

https://www.cdc.gov/mmwr/volumes/71/wr/mm7123a4.htm


QuickStats: Rate of Deaths Attributed to Unintentional Injury from Fire or Flames, by Sex and Urban-Rural Status — National Vital Statistics System, United States, 2020

April 8, 2022

In 2020, the death rate attributed to unintentional injury from fire or flames was higher in rural areas than in urban areas for females and males.

The rate for females was 1.4 per 100,000 in rural areas and 0.6 in urban areas.

The rate for males was 2.4 per 100,000 in rural areas and 0.9 in urban areas.

Males had higher death rates than females in both rural and urban areas.

Source: National Center for Health Statistics, National Vital Statistics System, Mortality Data, 2020. https://www.cdc.gov/nchs/deaths.htm

https://www.cdc.gov/mmwr/volumes/71/wr/mm7114a5.htm


QuickStats: Death Rates Attributed to Excessive Cold or Hypothermia, by Urbanization Level and Sex — National Vital Statistics System, 2018–2020

February 18, 2022

During 2018–2020, death rates attributed to excessive cold or hypothermia were generally higher in more rural areas.

Among females, the death rate increased from 0.11 per 100,000 for those residing in large central metro areas, to 0.40 for those in noncore (rural) areas.

Among males, the death rates were lowest for those residing in large central metro areas (0.29) and large fringe metro areas (0.24), and highest in noncore (rural) areas (0.93).

Males had higher death rates than females for each corresponding urbanization level.

Source: National Center for Health Statistics, National Vital Statistics System, Mortality Data, 2018-2020. https://www.cdc.gov/nchs/nvss/deaths.htm

https://www.cdc.gov/mmwr/volumes/71/wr/mm7107a6.htm


QuickStats: Age-Adjusted Death Rates from Heart Disease Among Adults Aged 45–64 Years, by Urbanization Level and Sex — National Vital Statistics System, United States, 2019

November 19, 2021

In 2019, the age-adjusted death rate from heart disease among adults aged 45–64 years was 121.1 per 100,000 and was higher in rural counties (160.0) than urban counties (114.5).

Among men, the age-adjusted death rate from heart disease was 221.4 in rural counties and 165.1 in urban counties.

Among women, the age-adjusted death rate from heart disease was 99.5 in rural counties and 66.8 in urban counties. In each urbanization level, the rate was higher for men than for women.

Sources: National Vital Statistics System, Mortality Data, 2019. https://www.cdc.gov/nchs/nvss/deaths.htm; CDC Wonder online database. https://wonder.cdc.gov/ucd-icd10.html

https://www.cdc.gov/mmwr/volumes/70/wr/mm7046a8.htm


Q & A with Author: Rural-urban Differences in Unintentional Injury Death Rates Among Children Aged 0-17: United States, 2018-2019

October 27, 2021

DB421_fig1Questions for Matthew Garnett, Health Statistician and Lead Author of “Rural-urban Differences in Unintentional Injury Death Rates Among Children Aged 0-17: United States, 2018-2019.”

Q: Can you describe what unintentional injury deaths are?

MG: Unintentional injury deaths include fatal injuries that were unintended, unplanned, and did not occur on purpose. In contrast, intentional injuries include homicide or assault and suicide or self-harm. Unintentional injury deaths include a wide array of mechanisms, with the four most common being: poisoning, motor vehicle crashes, drowning, and falls.


Q: How did the data vary by age groups?

MG: Rates of unintentional injury deaths differ across age groups. In both urban and rural areas, unintentional injury death rates were highest among children aged under 1 year, followed by a decline in the 1–4 and 5–13 age groups, and then increasing in the 14–17 group. Although this pattern was seen in both urban and rural areas, rural rates were consistently higher than urban rates for all age groups.

The high rates experienced among children under the age of 1 year were driven by high rates of suffocation (includes choking, asphyxiation, and strangulation). Among children aged 1-4 years, the leading mechanisms diverged based on urban-rural status, with drowning being the leading mechanism in urban areas, and with both drowning and motor vehicle traffic being the leading mechanism among in rural areas. In the older age groups, including those aged 5-13 and 14-17, motor vehicle traffic was the leading mechanism.

The decrease in overall rates from the under 1 year group to the 1-4 age group can be explained by a lower suffocation rates, which decreased from 24.9 in urban areas and 42.1 in rural areas among children under 1, to 0.7 and 1.1, respectively, in the 1-4 age group. The increase in overall rates between the 5-13 and 14-17 age groups is partially due to the increase in motor vehicle traffic rates, which increased from 1.5 in urban areas and 3.1 in rural areas among the 3-13 age group to 5.1 and 12.5, respectively, in the 14-17 age group.


Q: Do you have trend data that goes further back than 2018?

MG: This information is not presented in the report, but additional national data is available through CDC’s query system – CDC WONDER. Since 1999, rates of unintentional injury death among children aged 0-17 years have decreased from a high of 12.7 (per 100,000 population) in 1999 to 7.2 in 2019, a 43% decrease. Decreases were seen both in urban and rural areas. In urban areas the rate decreased from 11.0 in 1999 to 6.4 in 2019, a 42% decrease. In rural areas, the rate decreased from 21.5 in 1999 to 12.7 in 2019, a decrease of 41%. The unintentional injury death rate has decreased among children in both areas between 1999 and 2019; however, the gap between urban and rural rates has been maintained over time.

Rates of Unintentional Injury Death Among Children Aged 0-17 Years by Urban-rural Status, United States, 1999-2019

Year

Total

Rate per 100,000

Urban

Rate per 100,000

Rural

Rate per 100,000

1999

12.7

11.0

21.5

2000

12.3

10.7

21.1

2001

11.9

10.4

20.3

2002

11.9

10.6

19.7

2003

11.5

10.0

20.2

2004

11.7

10.2

20.3

2005

11.1

9.7

19.4

2006

10.8

9.4

18.6

2007

10.7

9.5

17.6

2008

9.3

8.1

16.6

2009

8.6

7.5

14.9

2010

8.1

7.0

14.4

2011

8.0

6.9

14.2

2012

7.7

6.7

13.8

2013

7.4

6.4

13.2

2014

7.2

6.3

12.9

2015

7.6

6.7

13.6

2016

7.8

7.0

13.2

2017

7.7

6.8

13.4

2018

7.1

6.3

12.2

2019

7.2

6.4

12.7

NOTES: Unintentional injury deaths are identified using International Classification of Diseases, 10th Revision underlying cause-of-death codes V01–X59 or Y85–Y86. The decedent’s county of residence was classified as urban or rural based on the 2013 NCHS Urban–Rural Classification Scheme for Counties. Rates shown are crude rates (deaths per 100,000).

SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality.


Q: What is the main takeaway message here?

MG: There are two main takeaways here. The first is that when discussing unintentional injury deaths, there are disparities for children between urban and rural areas. These disparities are found across age groups, and across multiple injury mechanisms.

The second takeaway is that the reasons for unintentional injury deaths change with age. Among the youngest children, under 1 year of age, suffocation is the leading mechanism of death, with the highest rate of any mechanism for both urban and rural children across all age groups. Among slightly older children aged 1-4 years, the leading mechanism becomes motor vehicle traffic and drowning. After this age group, the mechanism with the highest rates is motor vehicle traffic for children aged 5-13 and 14-17. For all of these leading mechanisms, rates were higher for children in rural areas.


Q: What are the reasons why unintentional injury death rates are higher in rural vs. urban areas?

MG: Data from this report suggests that different mechanisms drive the overall unintentional injury rate for each age group. Urban-rural disparities between mechanisms provide insight into the larger disparities seen in the overall unintentional rates. For example, among children under the age of 1, the rural rate of deaths involving suffocation were significantly higher (42.1 per 100,000 population) than urban rates (24.9). For that age group, suffocation was a major driver of disparity seen in the total unintentional injury death rate, which was 48.8 for rural areas and 29.3 for urban areas.

Among children aged 1-4, all reportable mechanisms show significantly higher rates among children in rural areas compared to children in urban areas. For some mechanisms, these disparities are smaller, such as natural or environmental deaths where the rural rate was 0.5 compared to the urban rate of 0.3. In other mechanisms the disparity is larger, such as for deaths involving fire or flames, where the rural rate was 1.7 compared to the urban rate of 0.4, more than 4 times higher.  

Among children aged 5-13 and 14-17, not all mechanisms show a significant disparity. However, some of the largest drivers of the overall unintentional death rate (that is, mechanisms with a larger number of deaths) for each group did. For example, motor vehicle traffic death rates were twice as high in rural areas compared to urban areas for both age groups. 

This data brief does not get into the specific reasons for disparities within specific mechanisms. However, there is a wide body of research that has associated urban-rural differences in injury mortality to a variety of factors. These include differences in types of activities undertaken by children living in rural and urban areas and the built environments that they undertake these activities in. Studies have also suggested that differences in patterns of safety equipment use and the practice of safety-related behaviors may play a role in differing mortality rates. Access to care has also been pointed to as an issue, when considering first responder response times in rural settings compared to urban settings, and access to medical facilities, including high level trauma care. The introduction to the report cites several of these studies.

Additional information on unintentional injuries, and strategies to address unintentional injuries are available from the CDC’s National Center for Injury Prevention and Control.


Q & A: Trends in Death Rates in Urban and Rural Areas: United States, 1999–2019

September 21, 2021

DB417_cover1

Questions for Sally Curtin, Health Statistician and Lead Author of “Trends in Death Rates in Urban and Rural Areas: United States, 1999–2019.”

Q:  Why did you decide to do a report comparing death rates in rural and urban areas?

SC: In many of our reports, we have examined trends in various causes of death by urban-rural status.  However, we had not published data on trends in all-cause mortality by urban-rural status.  In addition, we had not analyzed death rates for all of the 10 leading causes of death by urban-rural status in one report.  Thus, we felt that a report showing national statistics on urban-rural disparities by leading causes of death might be informative to those interested in delving more into these findings at a state or local level.


Q:  How does the data vary by leading causes of death?

SC:  The data in this report present a compelling picture of rural health as the age-adjusted rates for all 10 leading causes of death were higher in rural than urban areas.  In addition, we show that the differences between rates in rural and urban areas were greatest for the top causes of heart disease, cancer and chronic lower respiratory diseases and the gap widened over the 1999-to-2019 period.


Q:  What is the take home message in this report

SC: The gap in mortality between rural and urban areas has widened over the last 20 years with the overall age-adjusted rate in rural areas increasing from 7% higher than in urban areas in 1999 to 20% higher by 2019.  In addition, higher death rates in rural than urban areas were evident for all 10 leading causes of death with the greatest differences for some of the top causes: heart disease, cancer, and chronic lower respiratory diseases.


Q:  Do you have any predictions to how 2020 death rates will look for urban/rural areas will look?

SC:  We (NCHS) are not into forecasting so I will not speculate, but I can tell you that a report on COVID-19 deaths by urban-rural status for 2020 is planned.


Q:  Any other comments?

SC: In the introduction of the report, we point out that there are health challenges that are greater in rural than urban areas such as more limited access to health care, less health insurance, and more poverty.  Hopefully the findings in this report will alert the research community, health practitioners, and the public that the mortality disparity between rural and urban areas is widening and cannot be pinpointed to just a few causes of death but extends to all 10 leading causes.


QuickStats: Age-Adjusted Death Rates for Cancer, by Urban-Rural Status and Sex — National Vital Statistics System, United States, 1999–2019

September 17, 2021

mm7037a8-f

Cancer death rates declined among males and females during 1999–2019 in urban areas from 249.6 per 100,000 to 168.4 for males and from 168.2 to 123.9 for females.

Rates also declined in rural areas from 262.4 to 195.6 for males and from 165.4 to 139.2 for females.

Throughout the period, cancer death rates were higher for males than females and in rural compared with urban areas, and the urban-rural differences widened over the period for both males and females.

Source: National Center for Health Statistics, National Vital Statistics System, Mortality Data. https://www.cdc.gov/nchs/nvss/deaths.htm

https://www.cdc.gov/mmwr/volumes/70/wr/mm7037a8.htm


QuickStats: Percentage of Adults Aged 18 Years or Older With Fair or Poor Health by Urbanization Level and Age Group

July 30, 2021

mm7030a3-f-v2

In 2019, the percentage of adults aged 18 years or older reported to be in fair or poor health was higher among those living in nonmetropolitan areas (20.3%) than among those living in metropolitan areas (14.5%).

Percentages in fair or poor health were higher in nonmetropolitan areas for those aged 18–39 years (10.9% versus 7.4%) and 40–64 years (22.9% versus 16.2%), but the difference by urbanization level did not reach statistical significance for adults aged 65 years or older (27.2% versus 24.7%).

The percentage reporting fair or poor health increased with age in both nonmetropolitan and metropolitan areas.

Source: National Center for Health Statistics, National Health Interview Survey, 2019. https://www.cdc.gov/nchs/nhis.htm

https://www.cdc.gov/mmwr/volumes/70/wr/mm7030a3.htm


Urban-rural Differences in Dental Care Use Among Adults Aged 18−64

July 7, 2021

DB412_Cover1Questions for Amy Cha, Health Statistician and Lead Author of “Urban-rural Differences in Dental Care Use Among Adults Aged 18−64.”

Q: How does the data vary by sex, race, and income level?

AC: In both urban and rural areas, the percentage of adults aged 18-64 who had a dental visit in the past 12 months was higher among women and non-Hispanic white adults than men and Hispanic adults. Also, the percentage of adults who had a dental visit increased as family income increased in both urban and rural areas.


Q: Why did you decide to look at dental visits by urbanicity?

AC: Studies have shown that disparities exist in access to and use of dental care, especially between rural and urban areas. So, we decided to look at dental visits by urbanicity.


Q: Were you surprised by any of the findings in this report?

AC: We were surprised that the percentage of adults aged 18-64 with a dental visit in the past 12 months was significantly different between those residing in urban and rural areas.


Q: What is the take home message in this report?

AC: This report examined urban-rural differences in dental care use among adults aged 18-64, and its variation by sex, race and ethnicity, and family income as a percentage of the federal poverty level.


Q: Anything else that you would like share from the report?

AC: It has been reported that persons living in rural areas were less likely to have a preventive dental visit, but more likely to seek emergency dental treatment than those residing in urban areas. As shown in this report, the lower percentage of dental care utilization in rural areas may be attributed to the lower density of dental care providers in these areas.


QuickStats: Percentage of Adults Aged 18 Years or Older with Diagnosed Chronic Obstructive Pulmonary Disease, by Urbanization Level and Age Group — National Health Interview Survey, United States, 2019

July 2, 2021

In 2019, the percentage of adults aged 18 years or older with diagnosed chronic obstructive pulmonary disease (COPD) was higher among those living in nonmetropolitan areas (8.0%) than among those living in metropolitan areas (4.0%).

Percentages were higher in nonmetropolitan areas for adults aged 45–64 years (10.0% versus 4.8%) and aged 65 years or older (14.5% versus 9.5%), but the difference by urbanization level was not statistically significant for adults aged 18–44 years (1.9% versus 1.2%).

The prevalence of diagnosed COPD increased with age in both nonmetropolitan and metropolitan areas.

Source: National Center for Health Statistics, National Health Interview Survey, 2019. https://www.cdc.gov/nchs/nhis.htm

https://www.cdc.gov/mmwr/volumes/70/wr/mm7026a3.htm