Public Health Research in Rural Communities

How CDC Studies and Reports on Rural Health Disparities

People who live in rural areas of the United States are more likely than urban residents to die prematurely from five of the leading causes of death: heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke.

CDC’s National Center for Chronic Disease Prevention and Health Promotion uses several approaches to help improve the health of rural residents. One approach is studying and reporting on rural health disparities and innovative programs to reduce those disparities.

Morbidity and Mortality Weekly Report series of 13 articles on rural health disparities reported on leading causes of death, health behaviors, diabetes education programs, and cancer deaths. In conjunction with this research effort, CDC developed a rural health website to share study results and offer resources.

Other recent CDC publications on rural and urban health differences have included a variety of topics, such as arthritis symptoms, chronic pain, and oral health:


Prevalence of arthritis and arthritis-attributable activity limitation by urban-rural county classification — United States, 2015. MMWR


Higher prevalence of hysterectomy among rural women than urban women: Implications for measures of disparities in uterine and cervical cancers. Journal of Rural Health

Interventions to increase breast and cervical cancer screening uptake among rural women: a scoping review. Cancer Causes & Control

Rural disparities in surgical care from gynecologic oncologists among Midwestern ovarian cancer patients. Gynecologic Oncology

Bridging the gap in potentially excess deaths between rural and urban counties in the United States. Public Health Reports

Impact of rurality on stage IV ovarian cancer at diagnosis: a Midwest cancer registry cohort study. Journal of Rural Health

Lung cancer incidence in nonmetropolitan and metropolitan counties — United States, 2007–2016. MMWR

Potentially excess deaths from the five leading causes of death in metropolitan and nonmetropolitan counties — United States, 2010–2017. MMWR Surveillance Summaries

Rural-urban and racial/ethnic disparities in invasive cervical cancer incidence in the United States, 2010–2014. Preventing Chronic Disease

Rural cancer control: bridging the chasm in geographic health inequity. Cancer Epidemiology, Biomarkers & Prevention

Chronic Obstructive Pulmonary Disease

Geographic differences in sex-specific chronic obstructive pulmonary disease mortality rate trends among adults aged ≥25 years — United States, 1999–2019. MMWR

Urban-rural county and state differences in chronic obstructive pulmonary disease — United States, 2015MMWR

Chronic Pain

Prevalence of chronic pain and high-impact pain among adults — United States, 2016MMWR


Disparities in recommended preventive care usage among persons living with diabetes in the Appalachian region. BMJ Open Diabetes Research and Care

Issues that impact type 2 diabetes self-management in rural communities. Journal of the American Association of Nurse Practitioners

Rural–urban disparities in the prevalence of diabetes and coronary heart diseaseJournal of the American Association of Nurse Practitioners

Residence in a distressed county in Appalachia as a risk factor for diabetes, Behavioral Risk Factor Surveillance System, 2006-2007. Preventing Chronic Disease

Geographic distribution of diagnosed diabetes in the U.S.: a diabetes belt. American Journal of Preventive Medicine

An emerging model for community health worker–based chronic care management for patients with high health care costs in rural Appalachia. Preventing Chronic Disease

Evaluating telehealth adoption and related barriers among hospitals located in rural and urban areas. The Journal of Rural Health

Heart Disease and Stroke

Weekend effect on in-hospital mortality for ischemic and hemorrhagic stroke in US rural and urban hospitals. Journal of Stroke and Cerebrovascular Diseases

Progress Toward Achieving National Targets for Reducing Coronary Heart Disease and Stroke Mortality: A County-Level Perspective. Journal of the American Heart Association

Widespread recent increases in county-level heart disease mortality across age groupsAnnals of Epidemiology

What is the evidence for existing state laws to enhance pre-hospital stroke care?  Division for Heart Disease and Stroke report

Improving stroke outcomes in rural areas through telestroke programs: an examination of barriers, facilitators, and state policiesTelemedicine Journal and E Health

Inflammatory Bowel Disease (IBD)

Urban-rural differences in health care utilization for inflammatory bowel disease in the USA, 2017. Digestive Diseases and Sciences

Nutrition, Physical Activity, and Obesity

CDC programs to reduce obesity in high obesity areas (HOP) special collection (rural focus)Preventing Chronic Disease

Trends in meeting physical activity guidelines among urban and rural dwelling adults, National Health Interview Survey, 2008-2017MMWR

National-level environmental perceptions and walking among urban and rural residents: informing surveillance of walkabilityPreventive Medicine

Sugar-sweetened beverage intake among adults, by residence in metropolitan and nonmetropolitan counties in 12 states and the District of Columbia, 2017Preventing Chronic Disease

Use of mass communication by public health programs in nonmetropolitan regionsPreventing Chronic Disease

Geographic and urban–rural differences in walking for leisure and transportationAmerican Journal of Preventive Medicine

Prevalence of Municipal-Level Policies Dedicated to Transportation That Consider Food Access. Preventing Chronic Disease

Public Health Representation on Active Transportation Bodies Across US Municipalities. Journal of Public Health Management and Practice

Racial and ethnic differences in perceived safety barriers to walking, United States National Health Interview Survey — 2015Preventive Medicine

Obesity Prevalence Among Adults Living in Metropolitan and Nonmetropolitan Counties — United States, 2016. MMWR

Oral Health

Disparities in Preventive Dental Care Among Children in GeorgiaPreventing Chronic Disease

Disparities in receipt of preventive dental services in children from low-income familiesAmerican Journal of Preventive Medicine

Multilevel model to estimate county-level untreated dental caries among US children aged 6–9 years using the National Health and Nutrition Examination Survey. Preventive Medicine

Visualizing county-level data to target dental safety-net programs for childrenPreventing Chronic Disease

Page last reviewed: September 1, 2022