Rural-Urban Health Disparities Persist with Higher Risk of Heart Failure

January 26, 2023 - New National Institutes of Health data adds to the literature documenting rural-urban health disparities, with this newest study finding that those living in rural regions are 19 percent more likely to develop heart failure than those living in urban areas.

The study, published in JAMA Cardiology, also found that Black men living in rural areas were 34 percent more likely to develop heart failure than Black men in urban areas.

The researchers said these findings are an important literature add for understanding both racial health disparities and geography-based disparities.

“We did not expect to find a difference of this magnitude in heart failure among rural communities compared to urban communities, especially among rural-dwelling Black men,” Véronique L. Roger, MD, MPH, the study’s corresponding author and a senior investigator with the Epidemiology and Community Health Branch in NHLBI’s Division of Intramural Research, said in a statement.

“This study makes it clear that we need tools or interventions specifically designed to prevent heart failure in rural populations, particularly among Black men living in these areas,” Roger added.

The researchers looked at data for over 27,000 adults living in the southeastern United States (Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, and West Virginia) as part of The Southern Community Cohort Study. Over 13 years, the researchers tracked whether rural- and urban-dwelling participants developed heart failure for the first time.

The one-fifth of participants who lived in rural areas were more likely to have developed heart failure over the course of the study, shaking out to a 19 percent higher likelihood than their urban counterparts, the researchers said.

Black race compounded that disparity. Black men living in rural areas were 34 percent more likely to develop heart failure than Black men living in rural areas. Meanwhile, Black women in rural areas were 18 percent more likely to develop heart failure than Black women who lived in urban regions.

Similar trends emerged for White women; White women living in rural areas were 22 percent more likely to develop heart failure than White urban-dwelling women.

The researchers found no association between heart failure risk and urban or rural residency for White men.

The study did not look into the reasons behind these geographic and racial health disparities, but they did posit that some factors, like limited access to resources, may have been influential. Structural racism could be credited to the racial disparities apparent in the data, the researchers suggested, while inequities in healthcare access and food insecurity could also be causing both the racial and geographic disparities.

Importantly, the researchers said these findings help make the case for more preventive care, both clinical and social.

“It is much easier to prevent heart failure than to reduce its mortality once you have it,” Sarah Turecamo, a study co-author, a fourth-year medical student at NYU’s Grossman School of Medicine, and a part of the NIH Medical Research Scholars Program, stated publicly.

Future research should assess the efficacy of different interventions tailored to closing these gaps, said David Goff, MD, PhD, the director of NHLBI’s Division of Cardiovascular Sciences.

“Finding an association between living in rural areas and an increased incidence of heart failure is an important advance, especially given its implications for helping to address geographic-, gender-, and race-based disparities,” Goff noted in the press release. “We look forward to future studies testing interventions to prevent heart failure in rural populations as we continue to fight heart disease, the leading cause of death in the U.S.”