Leading Causes of Death in Nonmetropolitan and Metropolitan Areas- United States, 1999-2014

Ernest Moy, Macarena C Garcia, Brigham Bastian, Lauren M Rossen, Deborah D Ingram, Mark Faul, Greta M Massetti, Cheryll C Thomas, Yuling Hong, Paula W Yoon, Michael F Iademarco, Ernest Moy, Macarena C Garcia, Brigham Bastian, Lauren M Rossen, Deborah D Ingram, Mark Faul, Greta M Massetti, Cheryll C Thomas, Yuling Hong, Paula W Yoon, Michael F Iademarco

Abstract

Problem/condition: Higher rates of death in nonmetropolitan areas (often referred to as rural areas) compared with metropolitan areas have been described but not systematically assessed.

Period covered: 1999-2014 DESCRIPTION OF SYSTEM: Mortality data for U.S. residents from the National Vital Statistics System were used to calculate age-adjusted death rates and potentially excess deaths for nonmetropolitan and metropolitan areas for the five leading causes of death. Age-adjusted death rates included all ages and were adjusted to the 2000 U.S. standard population by the direct method. Potentially excess deaths are defined as deaths among persons aged <80 years that exceed the numbers that would be expected if the death rates of states with the lowest rates (i.e., benchmark states) occurred across all states. (Benchmark states were the three states with the lowest rates for each cause during 2008-2010.) Potentially excess deaths were calculated separately for nonmetropolitan and metropolitan areas. Data are presented for the United States and the 10 U.S. Department of Health and Human Services public health regions.

Results: Across the United States, nonmetropolitan areas experienced higher age-adjusted death rates than metropolitan areas. The percentages of potentially excess deaths among persons aged <80 years from the five leading causes were higher in nonmetropolitan areas than in metropolitan areas. For example, approximately half of deaths from unintentional injury and chronic lower respiratory disease in nonmetropolitan areas were potentially excess deaths, compared with 39.2% and 30.9%, respectively, in metropolitan areas. Potentially excess deaths also differed among and within public health regions; within regions, nonmetropolitan areas tended to have higher percentages of potentially excess deaths than metropolitan areas.

Interpretation: Compared with metropolitan areas, nonmetropolitan areas have higher age-adjusted death rates and greater percentages of potentially excess deaths from the five leading causes of death, nationally and across public health regions.

Public health action: Routine tracking of potentially excess deaths in nonmetropolitan areas might help public health departments identify emerging health problems, monitor known problems, and focus interventions to reduce preventable deaths in these areas.

Figures

FIGURE 1
FIGURE 1
U.S. Department of Health and Human Services public health regions* * 1 = Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont; 2 = New Jersey, New York, Puerto Rico, and the U.S. Virgin Islands (Mortality data for residents of U.S. territories were excluded.); 3 = Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, and West Virginia; 4 = Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee; 5 = Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin; 6 = Arkansas, Louisiana, New Mexico, Oklahoma, and Texas; 7 = Iowa, Kansas, Missouri, and Nebraska; 8 = Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming; 9 = Arizona, California, Hawaii, and Nevada; 10 = Alaska, Idaho, Oregon, and Washington.
FIGURE 2
FIGURE 2
Age-adjusted death rates among persons of all ages for five leading causes of death in nonmetropolitan and metropolitan areas,* by year — National Vital Statistics System, United States, 1999–2014 * Nonmetropolitan and metropolitan areas were identified using the Office of Management and Budget’s 2013 county-based classification scheme. (Source: Office of Management and Budget, White House. Revised delineations of metropolitan statistical areas, micropolitan statistical areas, and combined statistical areas, and guidance on uses of the delineations of these areas. Washington, DC: Office of Management and Budget; 2013. https://www.whitehouse.gov/sites/default/files/omb/bulletins/2013/b13-01.pdf)
FIGURE 3
FIGURE 3
Number of potentially excess deaths* among persons aged † Nonmetropolitan areas were identified using the Office of Management and Budget’s 2013 county-based classification scheme. (Source: Office of Management and Budget, White House. Revised delineations of metropolitan statistical areas, micropolitan statistical areas, and combined statistical areas, and guidance on uses of the delineations of these areas. Washington, DC: Office of Management and Budget; 2013. https://www.whitehouse.gov/sites/default/files/omb/bulletins/2013/b13-01.pdf)
FIGURE 4
FIGURE 4
Percentage of potentially excess deaths* among persons aged † Nonmetropolitan and metropolitan areas were identified using the Office of Management and Budget’s 2013 county-based classification scheme. (Source: Office of Management and Budget, White House. Revised delineations of metropolitan statistical areas, micropolitan statistical areas, and combined statistical areas, and guidance on uses of the delineations of these areas. Washington, DC: Office of Management and Budget; 2013. https://www.whitehouse.gov/sites/default/files/omb/bulletins/2013/b13-01.pdf)
FIGURE 5
FIGURE 5
Percentage of potentially excess deaths* among persons aged § — National Vital Statistics System, United States, 2014 * For each age group and cause, the death rates of the three states with the lowest rates during 2008−2010 (benchmark states) were averaged to produce benchmark rates. Potentially excess deaths were defined as deaths among persons aged † Nonmetropolitan and metropolitan areas were identified using the Office of Management and Budget’s 2013 county-based classification scheme. (Source: Office of Management and Budget, White House. Revised delineations of metropolitan statistical areas, micropolitan statistical areas, and combined statistical areas, and guidance on uses of the delineations of these areas. Washington, DC: Office of Management and Budget; 2013. https://www.whitehouse.gov/sites/default/files/omb/bulletins/2013/b13-01.pdf) §1 = Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont; 2 = New Jersey and New York; 3 = Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, and West Virginia; 4 = Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee; 5 = Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin; 6 = Arkansas, Louisiana, New Mexico, Oklahoma, and Texas; 7 = Iowa, Kansas, Missouri, and Nebraska; 8 = Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming; 9 = Arizona, California, Hawaii, and Nevada; 10 = Alaska, Idaho, Oregon, and Washington.

References

    1. Kusmin L. Rural America at a glance, 2015 edition. Economic Information Bulletin No. (EIB-145). Washington, DC: US Department of Agriculture; 2015.
    1. Eberhardt MS, Ingram DD, Makuc DM, et al. Urban and rural health chartbook. Health, United States, 2001. Hyattsville, MD: National Center for Health Statistics, CDC; 2001.
    1. Meit M, Knudson A, Gilbert T, et al. The 2014 update of the rural-urban chartbook. Grand Forks, ND: Rural Health Reform Policy Research Center; 2014.
    1. Shaw KM, Theis KA, Self-Brown S, Roblin DW, Barker L. Chronic disease disparities by county economic status and metropolitan classification, Behavioral Risk Factor Surveillance System, 2013. Prev Chronic Dis 2016;13:160088. 10.5888/pcd13.160088
    1. Agency for Healthcare Research and Quality. 2014 national healthcare quality and disparities report chartbook on rural health care. AHRQ Pub. No. 15–0007–9-EF. Rockville, MD: Agency for Healthcare Research and Quality; 2015.
    1. Kochanek KD, Murphy SL, Xu JQ, Tejada-Vera B. Deaths: final data for 2014. Natl Vital Stat Rep 2016;65(4).
    1. Yoon PW, Bastian B, Anderson RN, Collins JL, Jaffe HW. Potentially preventable deaths from the five leading causes of death—United States, 2008-2010. MMWR Morb Mortal Wkly Rep 2014;63:369–74.
    1. Garcia MC, Bastian B, Rossen LM, et al. Potentially preventable deaths from the five leading causes of death, update, United States, 2010. MMWR Morb Mortal Wkly Rep 2016;63:369–74.
    1. Office of Management and Budget, White House. Revised delineations of metropolitan statistical areas, micropolitan statistical areas, and combined statistical areas, and guidance on uses of the delineations of these areas. Washington, DC: Office of Management and Budget; 2013.
    1. Coburn AF, MacKinney AC, McBride TD, Mueller KJ, Slifkin RT, Wakefield MK. Choosing rural definitions: implications for health policy. Iowa City, IA: Rural Policy Research Institute; 2007.
    1. Taylor JR. An introduction to error analysis. Sausalito, CA: University Science Books; 1997.
    1. Kim HJ, Fay MP, Feuer EJ, Midthune DN. Permutation tests for Joinpoint regression with applications to cancer rates. Stat Med 2000;19:335–51. 10.1002/(SICI)1097-0258(20000215)19:3<335::AID-SIM336>;2-Z
    1. National Advisory Committee on Rural Health and Human Services. Mortality and life expectancy in rural America: connecting the health and human service safety nets to improve health outcomes over the life course. Rockville, MD: National Advisory Committee on Rural Health and Human Services; 2015.
    1. Strine TW, Beck LF, Bolen J, Okoro C, Dhingra S, Balluz L. Geographic and sociodemographic variation in self-reported seat belt use in the United States. Accid Anal Prev 2010;42:1066–71. 10.1016/j.aap.2009.12.014
    1. Faul M, Dailey MW, Sugerman DE, Sasser SM, Levy B, Paulozzi LJ. Disparity in naloxone administration by emergency medical service providers and the burden of drug overdose in U.S. rural communities. Am J Public Health 2015;105(Suppl 3):e26–32. 10.2105/AJPH.2014.302520
    1. CDC. Best practices for comprehensive tobacco control programs—2014. Atlanta, GA: US Department of Health and Human Services, CDC; 2014.
    1. Khan LK, Sobush K, Keener D, et al.; CDC. Recommended community strategies and measurements to prevent obesity in the United States. MMWR Recomm Rep 2009;58(No. RR–7).
    1. US Department of Health and Human Services. The health consequences of smoking—50 years of progress: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, CDC; 2014.
    1. US Department of Health and Human Services. The Surgeon General’s vision for a healthy and fit nation. Rockville, MD: US Department of Health and Human Services, Office of the Surgeon General; 2010.
    1. Guy GP Jr, Tangka FK, Hall IJ, Miller JW, Royalty J. Forward. The reach and health impacts of the national breast and cervical cancer early detection program. Cancer Causes Control 2015;26:649–50. 10.1007/s10552-015-0561-0
    1. Frieden TR, Berwick DM. The “Million Hearts” initiative—preventing heart attacks and strokes. N Engl J Med 2011;365:e27. 10.1056/NEJMp1110421

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit