Rural-Urban Cardiovascular Mortality Gap Widens, Especially Among Younger Adults

A recent analysis of U.S. death certificate data from 2010 to 2022 has uncovered a widening gap in cardiovascular mortality rates between rural and urban areas, with younger adults in rural regions facing the most significant increases. The study, to be presented at the American Heart Association's Scientific Sessions 2024 and published in the Journal of the American College of Cardiology, reveals alarming trends that underscore the need for targeted interventions in rural healthcare.

Researchers examined data for over 11 million adults, finding that cardiovascular disease death rates increased by approximately 21% for adults aged 25-64 living in rural areas. In contrast, rates declined by about 9% for adults 65 or older in urban areas. This disparity became even more pronounced following the onset of the COVID-19 pandemic in 2020, with rural areas experiencing a more substantial increase in cardiovascular mortality compared to urban regions across all age groups.

The study's lead author, Dr. Lucas X. Marinacci, a cardiology fellow at Beth Israel Deaconess Medical Center, noted that rural communities face a disproportionate burden of cardiovascular risk factors, economic hardship, and healthcare system challenges. These issues, including hospital closures, physician shortages, and lack of public health infrastructure, were further exacerbated by the pandemic.

The analysis revealed that between 2010 and 2022, the age-adjusted cardiovascular mortality rate increased by 0.8% in rural areas but decreased by 6.4% in urban areas. Younger rural adults aged 25-64 experienced a striking 21% relative increase in their cardiovascular death rate, while their urban counterparts saw only a 3% increase. Conversely, adults over 65 experienced declines in cardiovascular mortality rates in both rural and urban areas, though the improvement was more substantial in urban regions.

The COVID-19 pandemic appears to have accelerated these trends, with cardiovascular death rates increasing nationwide but showing a significantly larger relative increase in rural (8.3%) versus urban (3.6%) areas after 2020. Dr. Marinacci suggests that the pandemic's impact on healthcare access, affordability, and overall psychosocial distress may have contributed to the widening rural-urban disparities.

These findings highlight an urgent need for targeted public health initiatives focused on reducing cardiovascular risk among working-age rural adults. Suggestions for improvement include implementing community health worker programs to strengthen connections between rural adults and healthcare resources, as well as policy interventions to enhance access to affordable healthcare and increase insurance coverage in rural populations.

The study's results carry significant implications for public health policy and healthcare resource allocation. As rural communities continue to face unique challenges in cardiovascular health, including higher burdens of risk factors like Type 2 diabetes and hypertension, as well as limited access to specialty care and cardiovascular technologies, innovative solutions are needed. Dr. Karen E. Joynt Maddox, chair of an American Heart Association Presidential Advisory, emphasizes the potential of telehealth-based specialist visits and policy interventions to improve care affordability as potential strategies to address these alarming trends.

As the rural-urban cardiovascular mortality gap continues to widen, particularly among younger adults, this research underscores the critical importance of developing targeted, effective interventions to improve cardiovascular health outcomes in rural America. The findings serve as a call to action for policymakers, healthcare providers, and public health officials to address these disparities and work towards equitable health outcomes for all Americans, regardless of their geographic location.