WASHINGTON, July 12, 2017 - Rural Americans contract cancer less often than their urban counterparts, but are more likely to die from it, according to a new Centers for Disease Control and Prevention report that highlights the health care challenges faced by rural residents.
In addition, a higher percentage of rural residents contract certain cancers, “including those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers,” CDC said in announcing the report.
Cancer death rates were higher in rural areas compared with urban areas (180 deaths per 100,000 persons versus 158 deaths per 100,000), CDC said. One factor contributing to the urban-rural disparity in death rates is that “cancer deaths in rural areas decreased at a slower pace,” CDC said. From 2006-2015, “death rates for all cancer sites combined decreased more slowly in nonmetropolitan counties (-1 percent per year) than in metropolitan counties (-1.6 percent per year),” according to the report, which CDC said is “the first comprehensive description of cancer incidence and mortality in nonmetropolitan and metropolitan counties” in the U.S.
“While geography alone can’t predict your risk of cancer, it can impact prevention, diagnosis and treatment opportunities – and that’s a significant public health problem in the U.S.,” CDC Acting Director Anne Schuchat said. “Many cancer cases and deaths are preventable, and with targeted public health efforts and interventions, we can close the growing cancer gap between rural and urban Americans.”
But rural residents have fewer choices than urban ones when it comes to health care. A recent report from the Chartis Center for Rural Health said 80 rural hospitals have closed since 2010 “and research indicates that many more are struggling to stay open,” just one sign that that “the rural health safety net continues to unravel, putting the mission to care for rural populations in jeopardy in a number of states.” The report also notes that 41 percent of rural hospitals are operating at a negative margin.
In addition, rural counties are more likely to have only one insurer. On average, metro-area counties have 2.5 insurers participating in health care exchanges in 2017, compared to two insurers in non-metro counties, according to a recent Kaiser Family Foundation study.
“There’s been a lot of concern recently whether markets are really sustainable when in a lot of markets there’s just one insurer,” said Cynthia Cox, associate director for KFF’s Program for the Study of Health Reform and Private Insurance. “Very few cities have only one insurer. It’s more of a problem in rural areas.”
The problem is particularly acute in the South and Midwest, Cox said.
The CDC report said that “nonmetropolitan rural counties generally experienced lower incidence rates than metropolitan counties for female breast cancer, late-stage female breast cancer, and prostate cancer but higher incidence rates for lung cancer, late-stage lung cancer, colorectal cancer, late-stage colorectal cancer, and cervical cancer.”
Previous research has shown that rural residents have higher rates of cancer risk factors such as cigarette smoking, obesity, and physical inactivity, CDC said. Data from 2013 show that 27 percent of rural adults reported engaging in four of five healthy behaviors, defined as “sufficient sleep, current nonsmoking, nondrinking or moderate drinking, maintaining normal body weight, and meeting aerobic leisure time physical activity recommendations.” Approximately one-third of U.S. adults “practice at least four of these five behaviors,” according to that study, which came out earlier this year.
House and Senate healthcare legislation would make matters worse for rural residents, who tend to be older and have lower incomes than their urban counterparts, KFF’s Cox said. Her group’s analysis of the House’s American Health Care Act (AHCA) says that in general, “people who are older, lower-income, or live in high-premium areas (like Alaska and Arizona) receive less financial assistance under the AHCA. Additionally, older people would have higher starting premiums under the AHCA and would therefore pay higher premiums.”
The Senate bill “keeps more of Obamacare,” she said, and hypothetically, would result in a lower increase in premiums than the House bill.