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

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.

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

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

Number of potentially excess deaths* among persons aged <80 years for five leading causes of death in nonmetropolitan areas,† by year — National Vital Statistics System, United States, 2010–2014 * 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 <80 years in excess of the number that would be expected if the age-specific death rates of the benchmark states occurred across all states. ^† 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

Percentage of potentially excess deaths* among persons aged <80 years for five leading causes of death in nonmetropolitan and metropolitan areas† — 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 <80 years in excess of the number that would be expected if the age-specific death rates of the benchmark states occurred across all states. ^† 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

Percentage of potentially excess deaths* among persons aged <80 years for five leading causes of death in nonmetropolitan and metropolitan areas,† by year and public health region^§ — 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 <80 years in excess of the number that would be expected if the age-specific death rates of the benchmark states occurred across all states. ^† 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.