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The Collective for Health Equity and Well-Being

Cooperative Extension’s Collective for Health Equity and Well-Being is a community of Extension personnel and their partners united by their shared commitment to advancing health equity and well-being. Members work together to support the implementation of Cooperative Extension’s National Framework for Health Equity and Well-Being (2021) to ensure that all people can be as healthy as they can be.

Dying Early in Rural America


A recently released report in CDC’s Morbidity and Mortality Weekly Report (MMWR) shows the gap in preventable premature mortality (or early death) between rural and urban America is growing wider. People living in rural areas are at a higher risk of dying early from one of the five leading causes of death when the death could have been prevented compared to people living in urban areas.

This report is an extension of the 2019 CDC study, which showed the percentage of preventable early deaths from the five leading causes was higher in rural counties compared with urban counties during 2010–2017. It extends the study period by including mortality data for additional years (2018-2022), expanding the analysis from 2010 to 2022. Below are some of the main findings, and a brief data visualization of the report is available here.


  • The percentage of preventable early cancer deaths among all premature deaths declined from 21% in 2010 to 0.3% in 2022. Regardless of metropolitan status, all county categories experienced declines.
  • However, declines in urban areas were larger than those in rural areas, which widened the rural-urban disparities in early cancer deaths.
  • Differences in tobacco use and less access to lung cancer screening facilities may explain some of this gap.

Unintentional injury

  • The percentage of preventable early deaths from unintentional injury increased from 2010 through 2019 (39% to 54%), followed by a steep increase from 2019 to 2021 and a slight decrease through June 2022 to 64%.
  • Increases in the percentage of preventable early deaths from unintentional injury during 2010-2022 were statistically significant for all rural-urban county categories except micropolitan (rural counties with small towns, population of 10,000 to 50,000 person).
  • Percentages were higher in rural areas than in urban areas, but the gap narrowed.
  • The worsening and expanding drug overdose epidemic, increases in motor vehicle traffic fatalities, and increases in falls drive the growth in early deaths from unintentional injury.


  • The percentage of preventable early deaths from stroke declined slightly from 2010 through 2019 (32% to 26%), followed by an increase to 34% through June 2022.
  • Each rural-urban county category experienced steep increases from 2019 to June 2022, except for the most rural counties, which experienced a slight decrease from 2021 to June 2022; rural counties had the highest percentage from January to June 2022 (42% in micropolitan counties and 41% in noncore counties).
  • Increases in 2020 and 2021 were likely associated with COVID-19-related conditions that contributed to risk-associated increased heart disease and stroke mortality, such as delayed or avoided emergency care treatment.
  • The highest percentages of preventable early deaths from stroke in 2022 were in southern states.

These findings can help guide local public health interventions to reduce risks of early death, while also highlighting the need to understand and address underlying social, environmental, and structural inequities contributing to disparities in preventable early deaths between rural and urban areas.

Access the full report and share this information with your network using our partner toolkit. This resource contains social media messages, graphics, and newsletter text you can use to help bring awareness of these findings and the need for more multi-sector approaches and focused interventions across the U.S. to reduce early death from the five leading causes. View CDC’s rural health website and  Rural Public Health At-A-Glance to find out what CDC is doing to improve the health and well-being of rural communities.

CDC Office of Rural Health

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