About 15 percent of the U.S. population lives in rural areas. These 46 million people tend to be older, poorer and sicker than urban Americans, with higher rates of cigarette smoking, high blood pressure and obesity and with lower rates of physical activity. They also don't use seat belts as often. They typically have less access to health care and are less likely to have health insurance.
Previous CDC research has identified that a substantial proportion of deaths in each of the five categories could have been avoided. But the data from the latest report showing more premature deaths in rural areas represent a new finding.
“There is a striking gap in health between rural and urban Americans,” said CDC Director Tom Frieden.
Rural America is where Americans are most in need of health care services yet often have the fewest options available, noted Alan Morgan, chief executive of the National Rural Health Association.
"When the federal government tries to address health disparities, it usually focuses on large population areas where they can get the most bang for the federal dollar," Morgan said. "And that leaves vast areas of America without a federal or state partnership on ensuring access to care."
Increasing death rates from heart disease and stroke, diabetes, drug overdoses, accidents and other conditions caused the nation's life expectancy to decline in 2015 for the first time in more than two decades, according to a report released last month by the National Center for Health Statistics.
Cigarette smoking remains the leading cause of preventable disease and death in the United States. Although smoking rates have declined overall in the past several years, tobacco use raises the risk for developing and dying from heart disease, stroke and chronic lower respiratory disease. Smoking prevalence among adults is higher in rural areas and differs markedly by region.
Unintentional injuries, which include overdoses from drugs, alcohol and other chemicals, as well as from motor vehicle crashes and other accidents, were about 50 percent higher in rural areas. That was in part because of greater risk of death from crashes and opioid overdoses.
Rates of opioid misuse and overdose death are among the highest among rural populations. Access to treatment is often delayed because emergency medical services take longer to reach injured or poisoned patients in rural areas. Rural areas also have fewer trauma centers with advanced equipment and specialized staff available at any hour.
Rural parts of the southeastern and southwestern public-health regions have the highest number of potentially preventable deaths. The southeastern states are Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina and Tennessee. The southwestern states are Arkansas, Louisiana, New Mexico, Oklahoma and Texas.
CDC officials said the new information about rural-urban disparities could help health-care providers in rural areas better address those gaps. Measures could include more comprehensive screening for high blood pressure and cancer, plus increased efforts to get residents to quit smoking and wear seat belts. They said providers in rural areas should also follow CDC guidelines to use more caution and consider alternatives before prescribing highly addictive narcotic painkillers.
Correction: An earlier version of this story incorrectly reported the number of deaths from the top five leading causes of death in 2014.