As the rural-urban mortality gap continues to expand, researchers have been exploring the reasons why the gap exists and how some of the deaths might be prevented. Studies show a higher percentage of rural residents die from preventable causes, specifically heart disease, cancer, unintentional injury, chronic lower respiratory disease,1 and stroke than urban residents.2,3 Researchers have also mapped deaths from specific causes with modifiable risk factors to estimate potentially preventable deaths.4 Building on this work, we use a new model to estimate differences in death rates due to modifiable risk factors. The notion of what is a preventable or avoidable death is difficult to capture, and subject to multiple definitions and thus empirical approaches. In this study, “ Risk Factors and Potentially Preventable Deaths in Rural Communities,” the North Carolina Rural Health Research Program used variation in three risk factors – smoking, obesity, and excessive alcohol use – to identify their relative contribution to common causes of mortality.
The goals of the study are to use our new approach to compare (1) the rates of potentially avoidable deaths between rural and urban communities in the United States; (2) how rates of potentially avoidable deaths vary by census region; and (3) the relative contribution of the selected modifiable risk factors to rates of potentially avoidable deaths (e.g., the effect of smoking relative to the effect of excessive alcohol use).
1. Primarily chronic obstructive pulmonary disease.
2. Moy E, Garcia MC, Bastian B, et al. Leading Causes of Death in Nonmetropolitan and Metropolitan Areas — United States, 1999–
2014. Morbidity and Mortality Weekly Report (MMWR) Surveillance Summaries, January 13, 2017;66(1);1-8. Available at: https://
3. Garcia MC, Faul M, Greta Massetti G, et al. Reducing Potentially Excess Deaths from the Five Leading Causes of Death in the Rural
United States. Morbidity and Mortality Weekly Report (MMWR) Surveillance Summaries, January 13, 2017;66(2):1-7 Available at:
4. Danaei G, Ding EL, Mozaffarian D, et al. The Preventable Causes of Death in the United States: Comparative Risk Assessment of
Dietary, Lifestyle, and Metabolic Risk Factors. PLoS Med, 2009 Apr;6(4):e1000058. Available at: https://journals.plos.org/