Rural/Urban Differences in Chronic Diseases and Delay of Needed Care

Research center:
Lead researcher:
Project funded:
September 2017
Project completed:
November 2018

Adult-onset chronic diseases including cardiovascular disease, congestive heart failure and cancers are leading causes of morbidity and mortality in the U.S. More than 17% of U.S. residents live in rural regions, including a disproportionate number of elderly, veteran or disabled adults. These populations have higher documented rates of morbidity and mortality associated with certain conditions, and are more likely to have uncontrolled or poorly managed chronic disease states. This project examined rural versus urban differences in the prevalence, incidence, stage and severity of selected chronic diseases including heart disease, stroke and these cancers: colon, breast, cervical, prostate, lung and skin. There was a focus on examining foregone or delayed access to preventive or needed care, and whether rural residents present later and with more advanced disease states. We utilized data from the Centers for Disease Control & Prevention Wonder, Health Care Utilization Project and Behavioral Risk Factor Surveillance System, utilizing ICD-9 and ICD10 codes and disease severity indices. For cancer estimates, we also used the Surveillance, Epidemiology and End Results cancer data to derive "stage at diagnosis of cancer" as a measure of delayed screening or foregone medical care.


  • Cancer Mortality in Rural America: 1999-2016
    Policy Brief
    Southwest Rural Health Research Center
    Date: 11/2018
    This policy brief details the differences in mortality from cancer at various levels of rurality in America. The primary aim of this study was to understand the scope of cancer mortality in urban and rural areas of the U.S. Common cancer types—breast, cervical, lung, prostate, and colon—were analyzed over an 18-year period from 1999-2016.
  • Congestive Heart Failure-Related Hospital Deaths Across the Urban-Rural Continuum in the United States
    Journal Article
    Southwest Rural Health Research Center
    Date: 12/2019
    This study examines congestive heart failure (CHF)-related, in-hospital mortality across six levels of rurality and four census regions. Results indicated CHF-related hospital admissions in small metropolitan, micropolitan, and noncore areas, compared to large central metropolitan areas, were more likely to result in death.
  • Individual- and County-Level Predictors of Cervical Cancer Screening: A Multi-Level Analysis
    Journal Article
    Southwest Rural Health Research Center
    Date: 05/2018
    Despite gains in cervical cancer screening, persistent socio-economic, geographical, racial, and ethnic disparities remain. The objective of this study was to examine the combined effect of individual- and county-level characteristics on the use of cervical cancer screening tests such as Papanicolaou (Pap) tests in Texas.
  • Prevalence and Mortality of Heart Disease and Related Conditions: Disparities Affecting the South, Rural Areas, and American Indian and Alaska Natives
    Policy Brief
    Southwest Rural Health Research Center
    Date: 11/2019
    This policy brief identifies trends in the prevalence of stroke, heart disease, and heart attack while also assessing trends in mortality for heart disease and related conditions across the nation. The study examined whether disease-related mortality and prevalence varied across place and time.