The Centers for Disease Control and Prevention has documented a widening divide in preventable early deaths between urban and rural areas. In 1999, the death rate in rural areas was 7% higher than in urban areas. It was 20% higher in 2019.
The study looked at deaths from the top five leading causes in the U.S.: cancer, heart disease, stroke, unintentional injuries (including drug overdoses) and chronic lower respiratory disease. COVID-19 was among the top five causes of death for some of the study period but was not included.
The number of preventable deaths was calculated by comparing the average mortality rate for people under 80 with each condition in the three states with the lowest mortality. Deaths above that rate were considered preventable early deaths.
According to the study’s lead author, Macarena C. Garcia, “preventable early deaths from heart disease were consistently higher in rural counties before COVID-19, and the disparities widened between the most rural county category and suburban counties.”
The CDC attributes part of this disparity to age as rural populations are older on average than urban ones. Still, they wrote that “differences in social circumstances, socioeconomic characteristics, health-related behaviors, and access to health care services affect mortality and potentially contribute to approximately half of all preventable premature deaths.”
In Utah, a large barrier to health access in rural areas is recruiting. DeAnn Brown, director of Garfield Memorial Hospital in Panguitch, Utah, said her hospital “just had one of our physicians who was going to retire. We figure it’s going to take us probably at least 18 months, if not longer, to find somebody with the qualifications.”
Because of staffing, the hospital had to cancel its mobile clinic this summer. In previous years it went to remote areas to treat patients who live more than an hour away from the hospital.
When it comes to getting specialty care, transportation is even more of a challenge in remote areas. Garfield Memorial can’t provide it, so “those people who live out in Escalante or Boulder would have to travel probably to Cedar City, which is about two to 2.5 hours for them. If they go to St. George, they're adding another hour or so. That would be the closest specialist.”
The hospital in Garfield County already provides – and hopes to expand access to – telehealth. That allows patients to see a doctor for smaller issues from their homes without a long trip to a clinic. Still, Brown said in those contexts “it's difficult if a physician or provider needs to put hands on a patient–look in their ears or listen to their heart.”
And, she said, people just don’t come in and get help when they need it. Sometimes that’s because of severe economic struggles – and a lot of people don’t have insurance.
Other times, it’s a cultural thing.
“They're just kind of a tough kind of population and put up with stuff and, and learn to get by when maybe they should seek help.”
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