Disparities in cardiometabolic mortality worsened since 1999
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Disparities in cardiometabolic mortality worsened between 1999 and 2017 between rural and urban Americans and within all race and sex groups for heart disease and diabetes, researchers found.
“We found that the rural-urban disparity was greatest in the South,” Sadiya S. Khan, MD, MSc, assistant professor of medicine (cardiology) and preventive medicine (epidemiology) at Northwestern University Feinberg School of Medicine, told Healio. “Race disparities were consistent across all geographic areas, with Black men living in rural areas having the highest cardiometabolic rates of death. This is likely due to differences in underlying risk factors, social determinants of health and health system access.”
Age-adjusted mortality rates
In the study published in the Journal of the American College of Cardiology, Nilay S. Shah, MD, MPH, cardiologist at Northwestern Medicine, and colleagues used data from death certificates from the CDC’s Wide-Ranging Online Data for Epidemiologic Research from 1999 to 2017 to determine age-adjusted mortality rates per 100,000 population from cerebrovascular disease, heart disease and diabetes. Age-adjusted mortality rates were calculated in race-sex groups in addition to by rurality across all and within census regions.
From 1999 to 2017, there were 2,405,818 deaths from heart disease, 548,544 deaths from cerebrovascular disease and 915,557 deaths from diabetes, all of with occurred in rural areas. For urban areas, there were 9,816,822 deaths from heart disease, 2,178,079 deaths from cerebrovascular disease and 3,551,458 deaths from diabetes.
In 1999, there were 1.06 rural deaths for heart disease per 100,000 population for each urban death for heart disease per 100,000 population. This increased to 1.21 in 2017 (P < .01). During this time period, this ratio also increased for diabetes (1.09 to 1.3; P < .01) but was stable for cerebrovascular disease (1.13 to 1.09; P = .27).
Among regions, the highest rural-urban ratio for age-adjusted mortality rates was in the South (heart disease, 1.32; cerebrovascular disease, 1.12; diabetes, 1.4). Ratios for heart disease were similarly low in the Midwest (1.08), Northeast (1.08) and the West (1.09). The West had the lowest ratios for cerebrovascular disease (0.96) and diabetes (1.01).
Black men from rural areas had the highest age-adjusted mortality rates for heart disease and cerebrovascular disease. Rural-urban age-adjusted mortality rate ratios for heart disease significantly increased over time in all race-sex groups, although it did not change for cerebrovascular disease for any race-sex group. From 1999 to 2017, age-adjusted mortality rate ratios for diabetes increased from 82 per 100,000 to 86 per 100,000 in rural areas and declined from 75 per 100,000 to 66 per 100,000 in urban areas. The rural-urban age-adjusted mortality rate ratio for diabetes increased during this time period for Black men (0.91 to 1.19; P < .01), Black women (1.11 to 1.39; P < .01), white men (1.07 to 1.27; P < .01) and white women (1.16 to 1.37; P < .01).
“Integrating telemedicine into our clinical practice will likely be beneficial,” Khan said in an interview. “We have seen great strides in how we incorporate telehealth during the COVID pandemic and may, in particular, offer rural residents greater access to health care providers. Integrating social determinants of health into our clinical practice and risk assessment across a variety of place-based health factors will be important.”
Need for national policies, federal funding
Khan added that more efforts are needed in this area as health care systems feel the effect of the COVID-19 pandemic. She said, “Rural areas have already faced hospital closures and loss of primary care physicians and lack of specialists. In the midst of the COVID pandemic, bankruptcies of health systems are increasingly worrisome for the growing rural-urban divide. National policies and federal funding supporting rural health systems are needed.”
For more information:
Sadiya S. Khan, MD, MSc, can be reached at s-khan-1@northwestern.edu; Twitter: @heartdocsadiya.
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