Preventable Premature Deaths from the Five Leading Causes of Death in Nonmetropolitan and Metropolitan Counties, United States, 2010-2022.

IF 37.3 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Macarena C García, Lauren M Rossen, Kevin Matthews, Gery Guy, Katrina F Trivers, Cheryll C Thomas, Linda Schieb, Michael F Iademarco
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In all county categories, preventable premature deaths from unintentional injury increased, with the largest increases occurring in large central metropolitan (+147.5%) and large fringe metropolitan (+97.5%) counties. Preventable premature deaths from CLRD decreased most in large central metropolitan counties where the benchmark was achieved in 2019 and increased slightly in noncore counties (+0.8%). In all county categories, preventable premature deaths from stroke decreased from 2010 to 2013, remained constant from 2013 to 2019, and then increased in 2020 at the start of the COVID-19 pandemic. Percentages of preventable premature deaths varied across states by urban-rural county classification during 2010-2022.</p><p><strong>Interpretation: </strong>During 2010-2022, nonmetropolitan counties had higher percentages of preventable premature deaths from the five leading causes of death than did metropolitan counties nationwide, across public health regions, and in most states. 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引用次数: 0

Abstract

Problem/condition: A 2019 report quantified the higher percentage of potentially excess (preventable) deaths in U.S. nonmetropolitan areas compared with metropolitan areas during 2010-2017. In that report, CDC compared national, regional, and state estimates of preventable premature deaths from the five leading causes of death in nonmetropolitan and metropolitan counties during 2010-2017. This report provides estimates of preventable premature deaths for additional years (2010-2022).

Period covered: 2010-2022.

Description of system: Mortality data for U.S. residents from the National Vital Statistics System were used to calculate preventable premature deaths from the five leading causes of death among persons aged <80 years. CDC's National Center for Health Statistics urban-rural classification scheme for counties was used to categorize the deaths according to the urban-rural county classification level of the decedent's county of residence (1: large central metropolitan [most urban], 2: large fringe metropolitan, 3: medium metropolitan, 4: small metropolitan, 5: micropolitan, and 6: noncore [most rural]). Preventable premature deaths were defined as deaths among persons aged <80 years that exceeded the number expected if the death rates for each cause in all states were equivalent to those in the benchmark states (i.e., the three states with the lowest rates). Preventable premature deaths were calculated separately for the six urban-rural county categories nationally, the 10 U.S. Department of Health and Human Services public health regions, and the 50 states and the District of Columbia.

Results: During 2010-2022, the percentage of preventable premature deaths among persons aged <80 years in the United States increased for unintentional injury (e.g., unintentional poisoning including drug overdose, unintentional motor vehicle traffic crash, unintentional drowning, and unintentional fall) and stroke, decreased for cancer and chronic lower respiratory disease (CLRD), and remained stable for heart disease. The percentages of preventable premature deaths from the five leading causes of death were higher in rural counties in all years during 2010-2022. When assessed by the six urban-rural county classifications, percentages of preventable premature deaths in the most rural counties (noncore) were consistently higher than in the most urban counties (large central metropolitan and fringe metropolitan) for the five leading causes of death during the study period.During 2010-2022, preventable premature deaths from heart disease increased most in noncore (+9.5%) and micropolitan counties (+9.1%) and decreased most in large central metropolitan counties (-10.2%). Preventable premature deaths from cancer decreased in all county categories, with the largest decreases in large central metropolitan and large fringe metropolitan counties (-100.0%; benchmark achieved in both county categories in 2019). In all county categories, preventable premature deaths from unintentional injury increased, with the largest increases occurring in large central metropolitan (+147.5%) and large fringe metropolitan (+97.5%) counties. Preventable premature deaths from CLRD decreased most in large central metropolitan counties where the benchmark was achieved in 2019 and increased slightly in noncore counties (+0.8%). In all county categories, preventable premature deaths from stroke decreased from 2010 to 2013, remained constant from 2013 to 2019, and then increased in 2020 at the start of the COVID-19 pandemic. Percentages of preventable premature deaths varied across states by urban-rural county classification during 2010-2022.

Interpretation: During 2010-2022, nonmetropolitan counties had higher percentages of preventable premature deaths from the five leading causes of death than did metropolitan counties nationwide, across public health regions, and in most states. The gap between the most rural and most urban counties for preventable premature deaths increased during 2010-2022 for four causes of death (cancer, heart disease, CLRD, and stroke) and decreased for unintentional injury. Urban and suburban counties (large central metropolitan, large fringe metropolitan, medium metropolitan, and small metropolitan) experienced increases in preventable premature deaths from unintentional injury during 2010-2022, leading to a narrower gap between the already high (approximately 69% in 2022) percentage of preventable premature deaths in noncore and micropolitan counties. Sharp increases in preventable premature deaths from unintentional injury, heart disease, and stroke were observed in 2020, whereas preventable premature deaths from CLRD and cancer continued to decline. CLRD deaths decreased during 2017-2020 but increased in 2022. An increase in the percentage of preventable premature deaths for multiple leading causes of death was observed in 2020 and was likely associated with COVID-19-related conditions that contributed to increased mortality from heart disease and stroke.

Public health action: Routine tracking of preventable premature deaths based on urban-rural county classification might enable public health departments to identify and monitor geographic disparities in health outcomes. These disparities might be related to different levels of access to health care, social determinants of health, and other risk factors. Identifying areas with a high prevalence of potentially preventable mortality might be informative for interventions.

2010-2022 年美国非大都市和大都市郡五大主要死因中可预防的过早死亡。
问题/条件:2019 年的一份报告量化了 2010-2017 年期间美国非大都市地区与大都市地区相比潜在超额(可预防)死亡的较高比例。在该报告中,疾病预防控制中心比较了 2010-2017 年期间国家、地区和州对非大都市县和大都市县五大死因造成的可预防过早死亡的估计值。本报告提供了更多年份(2010-2022 年)可预防的过早死亡估计值。覆盖时期:2010-2022 年:美国居民的死亡率数据来自国家人口动态统计系统,用于计算结果年龄段人群因五大死因造成的可预防的过早死亡:在 2010-2022 年期间,可预防的过早死亡在老年人中所占的百分比:在 2010-2022 年期间,非大城市县在五大死因中的可预防过早死亡比例高于全国、各公共卫生地区和大多数州的大城市县。在 2010-2022 年期间,就四种死因(癌症、心脏病、慢性肺部疾病和中风)而言,最偏远农村地区和最偏远城市地区之间在可预防的过早死亡方面的差距有所扩大,而在意外伤害方面的差距有所缩小。2010-2022 年期间,城市和郊区县(大型中心都市、大型边缘都市、中型都市和小型都市)可预防的意外伤害过早死亡人数有所增加,导致非核心县和微型都市县可预防的过早死亡人数比例已经很高(2022 年约为 69%),两者之间的差距缩小。2020 年,意外伤害、心脏病和中风导致的可预防的过早死亡急剧增加,而慢性阻塞性肺疾病和癌症导致的可预防的过早死亡继续下降。2017-2020 年间,CLRD 死亡率有所下降,但 2022 年有所上升。2020 年观察到多种主要死因的可预防过早死亡比例上升,这可能与 COVID-19 相关疾病有关,这些疾病导致心脏病和中风死亡率上升:公共卫生行动:根据城乡县级分类对可预防的过早死亡进行常规跟踪,可使公共卫生部门识别和监测健康结果的地域差异。这些差异可能与获得医疗保健的不同程度、健康的社会决定因素以及其他风险因素有关。确定潜在可预防死亡率较高的地区可能有助于采取干预措施。
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来源期刊
Mmwr Surveillance Summaries
Mmwr Surveillance Summaries PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-
CiteScore
60.50
自引率
1.20%
发文量
9
期刊介绍: The Morbidity and Mortality Weekly Report (MMWR) Series, produced by the Centers for Disease Control and Prevention (CDC), is commonly referred to as "the voice of CDC." Serving as the primary outlet for timely, reliable, authoritative, accurate, objective, and practical public health information and recommendations, the MMWR is a crucial publication. Its readership primarily includes physicians, nurses, public health practitioners, epidemiologists, scientists, researchers, educators, and laboratorians.
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