Rural health

Study: Death rates from chronic conditions rising in rural America

In rural America, more people die from chronic health conditions and substance abuse than in suburbs and cities, and the gap is widening.

A new study has found that the difference in rural and urban death rates tripled over the past 20 years mostly due to deaths among middle-aged white men and women (Source: “Study: Death rates from chronic conditions, 'deaths of despair' rising in rural U.S.,” United Press International, June 9).

This gap is partly due to access to care, but other factors also contribute, said lead researcher Dr. Haider Warraich, a cardiologist at Brigham and Women's Hospital in Boston and the VA Boston Healthcare System. In terms of access, rural areas have seen a wave of hospital closures driven largely by economics, especially during the COVID-19 pandemic, he said.

"But it's hard to disconnect health from other factors in our societies," Warraich said. "I think it's linked to the overall economic outlook of rural America as well, and also, health behaviors that contribute to poor health, such as poor nutrition, lack of exercise, smoking, substance use, etc."

For the study, which was published in the Journal of the American Medical Association, Warraich and his colleagues used federal government health data for 1999 through 2019. They found that age-adjusted death rates dropped in both rural and urban areas over that period. But the gap widened dramatically as death rates rose among white rural residents between 25 and 64.

Over the study period, rural death rates increased 12% for that group. Although death rates dropped among rural Black residents, they still had a higher death rate than all other groups in both rural and urban areas, researchers noted.

COVID-19 rates up in rural Ohio counties, down in urban counties

The rate of COVID-19 cases in some rural Ohio counties has begun to increase, while some urban centers are seeing improvement, state data shows (Source: “Data indicates COVID growing in rural counties, slowing in urban areas,” Springfield News Sun, Aug. 20, 2020).

The new data was released Thursday as part of a weekly update by the Ohio Department of Health. The counties each receive an advisory on a scale of 1-4 based on seven indicators of how prolific coronavirus is in a community. The full data for each county can be found at

Gov. Mike DeWine attributed the improvements in more urban counties to longer adoption of masking in public.

“What has happened is we’ve seen the urban areas with a bigger percentage of people wearing mask for a longer period of time and we’re seeing those numbers go down. Unfortunately we’re seeing those numbers go up in our rural areas,” DeWine said during his afternoon press conference.

On Friday afternoon, the Ohio Department of Health reported 113,046 cases of COVID-19 (an increase of 6,489 since last Friday), 12,719 hospitalizations (an increase of 591 this week) and 3,955 deaths (171 more reported since last Friday). The increase in cases and hospitalizations was smaller than last week, while the number of COVID-19 deaths is up slightly.

Trump administration greenlights Medicare telehealth services in rural areas

The Trump administration is taking steps to give telehealth a broader role under Medicare, with an executive order that serves as a call for Congress to make doctor visits via personal technology a permanent fixture of the program (Source: “Trump wants broader role for telehealth services in Medicare,” Associated Press, Aug. 3).

The order President Donald Trump signed on Monday applies to one segment of Medicare recipients — people living in rural communities. But administration officials said it’s intended as a signal to Congress that Trump is ready to back significant legislation that would permanently open up telehealth as an option for all people with Medicare.

Monday’s executive order will also set in motion an experiment under which hospitals in rural communities could receive a more predictable stream of Medicare payments in exchange for delivering better performance on certain measures of quality.

Rural areas with no hospital hit especially hard by COVID-19

A USA Today analysis found that new COVID-19 cases have been confirmed at faster rates in rural and nonmetropolitan counties since mid-March, which is when growth began to slow in hard-hit cities but sped up everywhere else (Source: “Rural communities without a hospital struggle to fight rising coronavirus cases, deaths,” USA Today via Canton Repository, May 15).

A similar trend can be seen in death counts: The tally of deaths rose fastest outside America’s major cities. And now, as the daily tally of new coronavirus cases starts to shrink in cities, it continues to grow in rural areas. For the week ending May 9, metropolitan counties announced 10% fewer new cases than the previous week. By comparison, rural counties announced 8% more cases than the previous week.

For residents in those communities, including those in the highest risk categories for COVID-19 — poor, elderly and suffering from underlying health conditions — a spate of recent hospital closures means the nearest emergency room is sometimes hours away and plagued by staff shortages and financial deficits.

Analysis: COVID-19 cases, deaths rising faster in rural areas

New COVID-19 cases and deaths are now rising faster in rural counties, according to new analysis (Source: “New coronavirus cases are rising faster in rural America. Some raise concerns as Ohio allows business to restart,” Lima News, May 7, 2020).

While the number of cases and deaths per 100,000 people is still lower in rural areas than in urban centers, a recent analysis from the Kaiser Family Foundation found that mostly rural counties saw a 125% increase in coronavirus cases and a 169% increase in coronavirus-related deaths in the two weeks prior to April 27, surpassing metro counties.

“I think in some rural communities the message hasn’t been communicated clearly enough that everyone is potentially at risk,” said Dr. Carrie Henning-Smith, a researcher with the University of Minnesota’s School of Public Health.

Rural counties are demographically at higher risk, too. These counties are older, on average, and have higher rates of underlying health conditions, higher rates of unemployment and higher poverty rates when compared to urban areas, Henning-Smith said.

CMS relaxes rules, allows telemedicine practice across state lines

The Trump administration has relaxed rules to enable doctors to remotely care for patients across state lines at rural facilities and let nurse practitioners perform more duties as workforce capacity becomes a major concern (Source: “CMS relaxes rules to boost capacity of providers as facilities tackle COVID-19 outbreak,” Fierce Healthcare, April 9, 2020).

The Centers for Medicare & Medicaid Services (CMS) announced a series of rules that will be relaxed for the duration of the public health emergency. The agency is trying to remove regulatory burdens facing providers swamped with treating the COVID-19 outbreak.

“It’s all hands on deck during this crisis,” said CMS Administrator Seema Verma in a statement. “All frontline medical professionals need to be able to work at the highest level they were trained for.”

Rural Ohioans struggle with behavioral health access, stigma


When it comes to rural parts of Ohio, stigma and access to behavioral health services are two barriers parents are forced to navigate when trying to help their child. There is only one child psychiatrist in southeast Ohio, in Athens County, and two in south central Ohio, in Lawrence County, according to the American Academy of Child and Adolescent Psychiatry (Source: “Rural Ohio struggles with access to mental health services,” Columbus Dispatch, March 2, 2020).

“The more you get out into those rural areas, the less opportunity you have for behavioral health care,” said Tony Coder, executive director of the Ohio Suicide Prevention Foundation. “There aren’t a number of providers in rural areas, and you combine that with the stigma and no one talking about it, it really is a perfect little storm that we’ve got going there.”

Rural parts of Ohio, especially southern, southeast and pockets of northwest Ohio, had the highest rates of suicide from 2014 through 2018, according to the state health department. For example, for every 100,000 residents in Appalachia’s Meigs County, nearly 24 died by suicide.

Federal legislation increases rural access to the opioid treatment drug, study finds 

Following the passage of federal legislation in 2016, Rural regions of the U.S. are obtaining increased access to opioid-withdrawal drug Buprenorphine, a new national study found (Source: “Study: Rural areas access to opioid treatment drug expanded under 2016 law Sen. Rob Portman backed,” The Columbus Dispatch, Dec. 5, 2019). 

study published in the journal Health Affairs, found that between 2016 and 2019, the number of doctors practicing in rural areas with waivers to prescribe Buprenorphine increased by 111 percent.

The increase follows the 2016 passage of the Comprehensive Addiction and Recovery Act (CARA), which was co-sponsored by Ohio Sen. Rob Portman. The law authorizes nurse practitioners and physician assistants to obtain the waivers needed to prescribe the medication. More than half of the federal waiver increases for nurse practitioners and physician assistants were due to the CARA law change in 2016, the study determined. 

“In order to address the drug addiction epidemic gripping our country, we need as many qualified providers as possible to treat patients who are struggling with addiction,” Portman said in a statement. 

Feds to prioritize telemedicine funding based on ‘rurality’

The Federal Communications Commission is moving forward with plans to reform how funding is distributed for the agency's rural telemedicine program (Source: “FCC to prioritize telemedicine funding by 'rurality',” Modern Healthcare, Aug. 1, 2019).

The FCC on Thursday voted to adopt a report and order for its Rural Health Care Program, which helps fund broadband and telecommunications services for some healthcare providers in rural areas. A major part of the program involves subsidizing the difference between urban and rural rates for telecommunications services.

To address increasing demand for the program, last summer the FCC increased funding for the Rural Health Care Program to $571 million per year, up from its initial funding cap of $400 million.

With the new report and order, the FCC said it will reform the way it distributes Rural Health Care Program funding and take steps to guard against possible waste and inefficiencies in program costs.

In the event program demand outpaces available funding, the FCC now plans to prioritize support based on "rurality tiers," as well as whether the Health Resources and Services Administration designates a provider's area as part of a medically underserved population.

Poll: Many rural Americans struggle to pay medical bills, access health care

A new national poll finds that while rural Americans are mostly satisfied with life, there is a strong undercurrent of financial insecurity that can create very serious problems for many people living in rural communities (Source: “Poll: Many Rural Americans Struggle With Financial Insecurity, Access To Health Care,” National Public Radio, May 21, 2019).

The findings come from two surveys National Public Radio conducted with the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health on day-to-day life and health in rural America.

Several findings stand out: A substantial number (40%) of rural Americans struggle with routine medical bills, food and housing. And about half (49%) say they could not afford to pay an unexpected $1,000 expense of any type.

One-quarter of respondents (26%) said they have not been able to get health care when they needed it at some point in recent years. That's despite the fact that nearly 9 in 10 (87%) have health insurance of some sort — a level of coverage that is higher now than a decade ago, in large part owing to the Affordable Care Act and the expansion of Medicaid in many states.