Connecticut’s rural residents die at higher rates than their city and suburban counterparts.

But a large percentage of those deaths may be preventable if better public health programs or better access to health care services were available, according to the latest data from the National Center for Health Statistics.

“We have excellent medical care as a general rule in the state,” state Rep. Susan Johnson, D-Windham, said. But rural and other high poverty areas, where many residents are on Medicaid rather than private health insurance, remain vulnerable to hospital service reductions and changes in eligibility for health care coverage, she said.

“My battle is to make sure the basic hospital services, like critical care units, are maintained in the small rural hospitals,” Johnson said. “If you take (hospital consolidation) in combination with the proposals to change the Affordable Care Act, that in combination would definitely decimate not just Connecticut, but most places around the country, in terms of access to health care.”

State mirrors nation

Of Connecticut’s 169 municipalities, 68 are classified as rural, based on population and number of people per square mile. They’re home to about 9 percent of the state’s 3.57 million population, or about 320,000 residents. In Fairfield County, Sherman, Redding and Easton are rural towns.

In Connecticut, rural residents were more likely than those living in cities and suburbs to die from four of the top five causes of death: heart disease, cancer, chronic lower respiratory disease and unintentional injury.

The state’s findings mirror national trends, according to a 2017 report published by the Centers for Disease Control, which analyzed data across the country from 1999 to 2014. Nationally, rural residents report higher rates of adverse health factors, such as smoking, obesity and lower use of seat-belts.

Connecticut’s death rate from heart disease in 2015 was about 60 per 100,000 people, but in rural areas, the rate was 72 per 100,000.

The cancer death rate was roughly 104 per 100,000 statewide but 127 per 100,000 in rural areas.

Rural residents in Connecticut were almost twice as likely to die from chronic lower respiratory disease, which includes asthma, chronic bronchitis and emphysema. And their death rate as a result of unintentional accidents was about 50 per 100,000 compared with a statewide rate of 38.

“The No. 1 issue is transportation,” said Mary Winar, manager of the state Office of Rural Health, which is based at Northwestern Connecticut Community College in Winsted.

Rural areas have fewer doctors, and they are more scattered. With public transportation centered in more urban areas, those living outside of cities often have to fend for themselves to get to appointments.

Nancy Heaton, CEO for the Foundation for Community Health in Sharon, said Litchfield County has studied options to improve transportation. Loop transit services aren’t practical in a rural setting, she said, and on-demand services can be costly.

The foundation has given grants to add trips through Geer’s Dial-A-Ride service and others like it. Still, when the foundation surveyed residents in the Connecticut and New York towns surrounding Sharon Hospital, 60 percent said transportation was one of the main barriers to accessing health care.

“People living here aren’t used to public transportation, so it takes a lot for people to get used to thinking about (it),” Heaton said. “They’re getting there through friends, and family, borrowing cars, or they’re just not going.”

Two Connecticuts

Connecticut is one of the top performers in the country in patient-to-doctor ratios, but its three predominantly rural counties, Windham, Tolland and Litchfield, ranked the lowest in the state in this category, according to 2017 County Health Rankings data published by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.

Windham County has 1,950 patients per primary care provider, compared with Fairfield County, with 1,110. The state average was 1,180.

Rural areas fare much worse in number of dentists, with Windham County, for example, showing 2,380 patients per dentist, about half the state average of 1,230. Fairfield County has 1,110 patients per dentist.

For several years, not one dentist in Litchfield County accepted adults on Medicaid, Heaton said, forcing those patients to travel to UConn Health center in Farmington for dental care. The foundation gave money to help the Community Health and Wellness Center in Torrington add dental services in 2008.

“Why is there a shortage of physicians over here? They don’t want to work over here,” said Arvind Shaw, the CEO of Generations Family Health Center. “That is not acceptable.”

“When you look at all these things, you can see all these anomalies,” Shaw said. “It’s because the state of Connecticut does not have a plan ... for health equity. There is not a system that actually maps resources.”

Carl Jordan Castro contributed reporting to this story.

This story was reported under a partnership with the Connecticut Health I-Team (www.c-hit.org )