Fast Facts: Rates of Chronic Conditions Consistently Higher Among Adults in Rural Areas

Rural populations face unique health challenges due to a complex mix

of economic, social, demographic and health workforce factors. They have distinctive characteristics — for example, rural areas are home to a higher proportion

 of older adults — and may experience financial insecurity

 and higher rates of unhealthy behaviors, as well as  shortages in the health care workforce that can make access to care

 a serious challenge. 

To better understand the impact of chronic conditions and their risk factors on rural populations, America’s Health Rankings^® examined data on three risk factors for chronic conditions — high blood pressure, obesity and high cholesterol — along with the prevalences of seven chronic conditions and those with multiple chronic conditions. When comparing rates among adults living in nonmetropolitan (“rural”) areas with those living in metropolitan areas,* it is clear that across nearly all measures, the prevalence is higher among adults living in rural areas compared to their metropolitan peers. 

The prevalence of high blood pressure was 1.22 times higher among adults living in rural areas (40.7%) compared with those in metropolitan areas (33.3%) in 2023. Between 2021 and 2023, the prevalence of high blood pressure worsened among adults living in both rural (from 39.0% to 40.7%) and metropolitan (from 31.6% to 33.3%) areas. While high blood pressure is a growing health challenge among all adults in the United States, the difference in prevalence between populations in rural and metropolitan areas has persisted over time.

In 2023, obesity prevalence was 1.19 times higher among adults living in rural areas (37.9%) compared with those in metropolitan areas (31.9%). In the same year, there was variation in the prevalence of obesity among adults living in rural areas by state, with the lowest rate in Massachusetts (23.2%) and the highest in Illinois (42.9%).

The prevalence of high cholesterol was 1.05 times higher among adults living in rural areas (39.2%) than those in metropolitan areas (37.2%) in 2023. However, the gap between the populations has narrowed since 2021, as the rate of high cholesterol has worsened among adults living in metropolitan areas (from 35.0% to 37.2%).

Chronic obstructive pulmonary disease (COPD) was 1.61 times more prevalent among adults living in rural areas (9.2%) relative to their counterparts living in metropolitan areas (5.7%) in 2023.

In 2023, the prevalence of cardiovascular diseases was 1.41 times higher among adults living in rural areas (11.7%) than those living in metropolitan areas (8.3%). In the same year, the prevalence of cardiovascular diseases varied by state, with adults living in rural areas in Utah (7.0%) having the lowest rate and those in West Virginia (16.2%) having the highest.

Adults living in rural areas had a 1.32 times higher prevalence of arthritis (32.0%) compared with adults living in metropolitan areas (24.2%) in 2023.

Adults living in rural areas (14.4%) had 1.24 times higher prevalence of diabetes compared with those in metropolitan areas (11.6%) in 2023. Diabetes worsened for both adults living in rural (13.4% to 14.4%) and metropolitan areas (10.9% to 11.6%) since 2021, with the difference between geographies persisting over time.

Cancer was 1.22 times more prevalent among adults living in rural areas (9.4%) compared with adults living in metropolitan areas (7.7%) in 2023. During that time, there was variation in cancer rates among adults living in rural areas by state, with the lowest prevalence in New Mexico (5.8%) and the highest in Nevada (14.3%).

In 2023, the prevalence of chronic kidney disease was 1.16 times higher among adults living in rural areas (4.3%) than in metropolitan areas (3.7%). Since 2021, chronic kidney disease rates have risen among adults living in both rural areas (3.7% to 4.3%) and in metropolitan areas (3.0% to 3.7%).

The prevalence of depression was 1.13 times higher among adults living in rural areas (22.3%) compared with those in metropolitan areas (19.8%) in 2023. Between 2021 and 2023, rates of depression increased among both adults living in rural areas (21.5% to 22.3%) and in metropolitan areas (19.2% to 19.8%); even as depression increased among the national adult population, the difference by geography persisted.

There is also a difference in the rate of multiple chronic conditions — defined as having three or more of the above chronic conditions — based on where one lives. The prevalence of multiple chronic conditions was 1.48 times higher among adults living in rural areas (14.4%) than those living in metropolitan areas (9.7%) in 2023.

America’s Health Rankings data consistently show that adults living in rural areas have higher rates of chronic conditions and risk factors than their metropolitan counterparts.

However, there is significant state-level variation in the rates of these conditions, how they have changed over time and the scale of the difference between rural and metropolitan populations — underscoring the importance of access to detailed, actionable data in specific geographic areas.

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