While Americans nationwide are healthier than they were 25 years ago, the health of persons in rural areas has declined, according to a new report from the Centers for Disease Control and Prevention (CDC).

Rural Americans, however, tend to smoke more, have more dental problems, age faster and die younger than persons in suburban areas, according to the report.

CDC researchers suggest that distances from state-of-the-art health care facilities and a higher rate of poverty may be the main reasons why.

"Even if they've got insurance, the biggest worry is: Do they have access to health care?" said Mary Wakefield, a rural health policy expert at George Mason University in Fairfax, Virginia.

According the Wakefield, rural residents in need of emergency medical treatment must often wait half-an-hour or longer for an ambulance. In addition, small hospitals serving rural areas are often forced to close due to a lack of available nurses.

In rural areas, health clubs, bike trails and other sources of recreation are often too far away, as are anti-smoking and diet programs.

"We think about this bucolic setting, but it doesn't necessarily lend itself to a lot of physical activity. The distance can preclude that," Wakefield said.

The CDC defines rural areas as counties without cities, and most are largely unincorporated areas with fewer than 10,000 people. Urban areas are considered large cities with more than 1 million people, while suburbs are larger towns on the fringes of the counties that have the largest cities. 

Suburbs are the healthiest places to live, according to the report. Violent death and drug abuse are more prevalent large urban areas, and urban Americans are less likely than suburban residents to have health insurance.

For instance: --10.6 percent of the wealthiest residents in rural areas and 10 percent of urban residents lacked health insurance in 1997 and 1998, compared with about 6.6 percent of suburbanites.

More statistics from Health, United States, 2001

37.6 percent of rural residents over 65 had edentulism, a total loss of teeth, in 1997 and 1998, compared with about 25.7 percent in the suburbs and 26.8 percent in cities.

18.9 percent of children age 12 to 17 in the most rural areas were regular smokers in 1999, compared with 11 percent in urban areas and 15.9 percent in the suburbs. Rural adults also smoked at higher rates than urban or suburban adults.

6.5 of men and women in the most rural areas did not exercise, play sports or pursue active hobbies in 1997 and 1998, compared with 40.9 percent of urban dwellers and 31.1 percent of suburbanites who were not fitness-minded.

The youth death rate from all causes was higher in rural areas from 1996 to 1998, as was the adult death rate.