When the rural areas saw a significant increase in cardiovascular deaths among younger adults, the urban areas saw declines during the same period. This is revealed in a study presented at the American Heart Association’s Scientific Sessions 2024. This highlights a growing urban-rural health disparity, especially after the onset of the COVID-19 pandemic.
Using data from the U.S. Centers for Disease Control and Prevention’s (CDC) WONDER database, researchers analyzed cardiovascular death rates for more than 11 million adults. This analysis covered the period between 2010 and 2022. The study focused on comparing deaths from heart related disease among people in rural and urban areas. Urban areas are defined as large metropolitan areas with populations exceeding one million people.
“Historically, rural areas have seen higher cardiovascular mortality rates, and the pandemic seems to have exacerbated these disparities,” said Dr. Lucas X. Marinacci, the study’s lead author and a cardiology fellow at Beth Israel Deaconess Medical Center. Dr. Marinacci and his team found a troubling trend. Cardiovascular deaths decreased by 9% for adults aged 65 and older in urban areas. Yet, younger adults in rural areas experienced a 21% increase in cardiovascular mortality during the same period.
KEY FINDINGS AND TRENDS
The study uncovered the following trends from 2010 to 2022:
- Cardiovascular death rates in rural areas increased by 0.8%, while they decreased by 6.4% in urban areas.
- For adults aged 25-64, cardiovascular deaths increased by 21% in rural areas. In contrast, there was a modest 3% increase in urban areas.
- For adults aged 65 and older, cardiovascular mortality decreased across both rural and urban areas. But the decline was more significant in urban areas (8.5%) than in rural areas (4.4%).
- Following the COVID-19 pandemic in 2020, cardiovascular death rates surged nationally. But, rural areas experienced a larger relative increase in cardiovascular deaths (8.3%) compared to urban areas (3.6%).
RURAL COMMUNITIES: STRUGGLING WITH CARDIOVASCULAR HEALTH
Dr. Marinacci pointed out that rural communities were already facing cardiovascular health challenges before the pandemic. These challenges included higher rates of Type 2 diabetes, hypertension, and limited access to specialized care. These issues were compounded by disruptions in health care coverage and accessibility during the pandemic, leading to worsening cardiometabolic health.
“Rural areas face unique challenges, including hospital closures, physician shortages, and limited access to cardiovascular technologies. These factors have worsened since the pandemic began. This situation makes it more difficult to control cardiovascular risk factors,” Marinacci said.
ADDRESSING THE URGENT NEED FOR INTERVENTION
The widening disparity in cardiovascular mortality calls for urgent public health interventions tailored to rural populations. Dr. Karen E. Joynt Maddox, chair of the American Heart Association’s Presidential Advisory on cardiovascular forecasting, stressed the need for targeted policy interventions. She emphasized healthcare solutions, such as telehealth for specialized care. Efforts to make health care more affordable are necessary.
“Aggressive risk factor modification is necessary to reverse these trends,” said Marinacci. He also advocated for the involvement of community health workers to improve access to healthcare and support chronic condition management, emphasizing the importance of improving insurance coverage for rural populations.
