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


QuickStats: Percentage of Adults Aged 18 or Older with Diagnosed Diabetes by Urbanization Level and Age Group

May 7, 2021

mm7018a4-fIn 2019, the percentage of adults aged 18 years or older with diagnosed diabetes was higher among those living in nonmetropolitan areas (12.4%) than among those living in metropolitan areas (8.9%).

Percentages of adults with diagnosed diabetes were higher in nonmetropolitan than metropolitan areas for those aged 18–44 years (3.5% versus 2.3%) and 45–64 years (15.2% versus 11.6%).

Among adults aged 65 years or older, the difference by urbanization level (21.9% in nonmetropolitan areas versus 19.8% in metropolitan areas) did not reach statistical significance.

The prevalence of diagnosed diabetes 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/mm7018a4.htm


Urban-Rural Differences in Drug Overdose Death Rates, 1999-2019

March 17, 2021

Questions for Holly Hedegaard, Health Statistician and Lead Author of “Urban-Rural Differences in Drug Overdose Death Rates, 1999-2019.”

Q: How do drug overdose death rates in urban and rural areas compare?

HH: Over the past 20 years, rates of drug overdose deaths have increased in both urban and rural areas. Rates in rural areas were higher than in urban areas from 2007 through 2015, but in 2016 that pattern changed. From 2016 through 2019, rates have been higher in urban areas than in rural areas.

Although urban rates are higher than rural rates nationally, for 5 states (California, Connecticut, North Carolina, Vermont, and Virginia), rates are higher in rural areas than in urban areas.


Q: Is this the most recent data you have on this topic?  When do you plan on releasing 2020 data?

HH: Final 2020 data won’t be released until the end of 2021. In the interim, monthly provisional estimates of drug overdose death rates are available at https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm


Q: Was there a specific finding in the data that surprised you from this report?

HH: In this report, we looked at trends in rates for drug overdose deaths involving certain types of opioids, including natural and semisynthetic opioids. This group includes such drugs as hydrocodone, oxycodone, and codeine – drugs that are often thought of as prescription opioids. In looking at the trends from 1999 through 2019, the rates of drug overdose deaths involving natural and semisynthetic opioids were higher in rural than in urban areas from 2004 through 2017, but in 2018 and 2019, the urban and rural rates were similar, because of a decline in the rates in rural areas. We will continue to monitor whether this decline in the rate continues.


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

HH: The key messages from this report are: 1) for the past 20 years, drug overdose death rates have increased in both urban and rural areas, and 2) there are urban-rural differences in the rates of drug overdose deaths involving specific types of drugs. For example, for the past 20 years, rates of drug overdose deaths involving cocaine or heroin have been consistently higher in urban areas than in rural areas. In contrast, in recent years, rates of drug overdose deaths involving psychostimulants (such as methamphetamine) have been higher in rural areas than in urban areas.


Q: Do you think rural counties will go back to having higher drug overdose death rates in the future?

HH: It’s impossible to predict what will happen in the future. While a lot of resources have been devoted to prevention and treatment of drug overdose in recent years, new drugs are becoming available all the time. NCHS will continue to monitor drug overdose deaths to identify patterns to help inform public health efforts.


QuickStats: Death Rates Attributed to Excessive Cold or Hypothermia† Among Persons Aged15 Years or older, by Urban-Rural Status and Age Group

February 19, 2021

In 2019, among persons aged 15 years or older, death rates attributed to excessive cold or hypothermia were higher in rural areas than in urban areas across every age group.

Crude rates were lowest among those aged 15–34 years at 0.2 and 0.5 per 100,000 population in urban and rural areas, respectively.

Rates increased with age, with the highest rates among those aged 85 years or older at 4.6 in urban areas and 8.6 in rural areas. Differences between urban and rural rates also increased with age.

Source: National Center for Health Statistics, National Vital Statistics System, Mortality Data 2019. https://wonder.cdc.gov/mcd-icd10.html

https://www.cdc.gov/mmwr/volumes/70/wr/mm7007a6.htm


Motor Vehicle Traffic Death Rates Among Adolescents and Young Adults Aged 15–24, by Urbanicity: United States, 2000–2018

October 8, 2020

Questions for Sally Curtin, Health Statistician and Lead Author of “Motor Vehicle Traffic Death Rates Among Adolescents and Young Adults Aged 15–24, by Urbanicity: United States, 2000–2018.”


Q: Was there a specific finding in the data that surprised you from this report?

SC: The finding that the difference in MVT death rates between persons aged 15-24 and 25 years and over has narrowed so much since 2000 so that the rate is only 7% higher for 15-24 year-olds in 2018.


Q: How did you obtain this data for this report?

SC: These data are from the National Vital Statistics System and come from the information from death certificates in the United States.  All of the rates in this report are reproducible from the CDC WONDER online database.


Q: How do you classify urban and rural areas?

SC: The National Center for Health Statistics developed a scheme (the latest published in 2013) to classify the urbanicity of counties by combining information on whether the county was considered to be part of a metropolitan area and the population of the county.  Based on this, there are four categories of Metropolitan (urban) counties, from largest to smallest, and two categories of rural counties.


Q: Is this the first report on motor vehicle deaths with an urban and rural breakdown?  Is there any trend data that goes back further than 2000?

SC: A recent NCHS report examined trends in MVT deaths by urban-rural classification but it was for all ages combined.  This is the first report to focus on trends in younger adults, aged 15-24, by urban-rural.

There is MVT trends data prior to 2000, although they are not entirely comparable to the data from 1999 to the present.  However, trends from 1980-1999 rates are generally downward.


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

SC: There has been great progress in reducing death rates to young adults aged 15-24, for whom this has been a leading cause of death.  However, the disparity in rates that still exist between rural and urban counties shows that there is more work to be done, particularly in the most rural areas.

 


QuickStats: Rates of Deaths Attributed to Unintentional Injury from Fire or Flames by Age Group and Urbanization Level

August 28, 2020

In 2018, the death rates attributed to unintentional injury from fire or flames were lowest among those aged 15–24 years and highest among those aged 75 years or older.

In rural areas, death rates decreased with age from 2.0 per 100,000 for persons aged 0–4 years to 0.3 for those aged 15–24 years, and then increased with age to 5.6 for those aged 75 years or older.

The pattern was similar for urban areas, where rates were 0.5 per 100,000 for persons aged 0–4 years, decreased to 0.1 for those aged 15–24 years, and then increased with age to 2.8 for those aged 75 years or older.

Across all age groups, death rates were approximately two to four times higher in rural areas compared with urban areas.

Source: National Center for Health Statistics, National Vital Statistics System, mortality data; 2018. https://www.cdc.gov/nchs/nvss/deaths.htm.

https://www.cdc.gov/mmwr/volumes/69/wr/mm6934a8.htm