People who live in rural areas are dying from cardiovascular disease at a much greater rate than those living in urban areas, according to a report presented at AHA 2024 and simultaneously published in JACC. The report shows that disparities in mortality are greater among younger adults and was more pronounced during the COVID-19 pandemic.

Lucas X. Marinacci, MD, et al., looked at cardiovascular deaths between 2010 and 2022 and found that mortality rates were consistently higher in rural areas when compared to urban areas or small/medium metropolitan areas. Deaths increased in rural areas from 431.6 to 435 per 100,000 over the 12-year period, but mortality rates in urban areas declined from 369.3 to 345.5 per 100,000. Among younger rural adults, rates increased even more, rising from 111 to 119 deaths per 100,000, which was a change not seen in urban areas or older subgroups. By 2022, rural adults were dying from cardiovascular disease at a rate 1.5-times higher than their urban counterparts.

"Leading up to the pandemic, cardiometabolic health was deteriorating in rural areas, particularly among younger adults," said Rishi Wadhera, MD, MPP, MPhil, senior author of the study. "Cardiometabolic risk factor control worsened during the pandemic, and rural areas may have been more severely affected due to greater interruptions in access to health care and worsening socioeconomic conditions. Social risk factors and 'diseases of despair' (substance use, depression and suicidality) also increased disproportionately in rural areas during the pandemic, which may have made rural adults more susceptible to poor cardiovascular outcomes."

Wadhera and colleagues say their findings underscore the need for "urgent action" to address the underlying social, economic and health system factors that contribute to worse cardiovascular health in rural communities. They highlight differences in socioeconomic factors, such as income, education and insurance coverage as accounting for a large proportion of rural-urban disparities in cardiovascular mortality in 2022.

"Without focused action, we risk deepening inequities that leave rural communities more vulnerable to preventable heart disease," said JACC Editor-in-Chief Harlan M. Krumholz, MD, SM, FACC.