HF-related death more prevalent within rural vs. urban communities
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HF-related death was more prevalent within rural counties compared with urban counites, according to data published in PLOS ONE.
The highest age-adjusted HF mortality rates were in rural Black men, and the highest average annual percent change in age-adjusted HF mortality rates was in rural Black men aged 35 to 64 years, the researchers wrote.
“In this nationwide study, we found marked county-level variation in HF-related mortality rates across the U.S., with a significantly greater burden in rural counties, especially those in the South,” Jacob B. Pierce, medical student at Northwestern University Feinberg School of Medicine, and colleagues wrote. “HF-related mortality rates increased in both rural and urban counties, with greater increases in HF-related mortality among younger compared with older adults between 2011 and 2018. Models accounting for differences in county-level factors significantly attenuated the excess in HF-related mortality rates in rural vs. urban counties.”
Utilizing the CDC WONDER databases to identify HF deaths from 2011 to 2018, researchers calculated the national age-adjusted mortality rates and assessed trends stratified by rural vs. urban status, age and race-sex subgroups per year. HF death was defined as CVD mortality with HF as a contributing cause.
Overall, there were 162,314 HF-related deaths in rural counties and 580,305 HF-related deaths in urban counties during this period.
Researchers found that the age-adjusted mortality rates were consistently higher among residents in rural counties (73.2 per 100,000 residents; 95% CI, 72.2-74.2) compared with those in urban counties (57.2 per 100,000 residents; 95% CI, 56.8-57.6) in 2018.
The highest rate of HF mortality was observed among Black men living in rural counties (131.1 per 100,000 residents in 2018; 95% CI, 123.3-138.9) and the greatest increases in HF-related mortality was among Black men aged 35 to 64 years (6.1% per year), the researchers wrote.
In a secondary analysis, researchers estimated incidence rate ratios (IRR) in HF-related mortality for rural vs. urban counties and adjusted for demographic and socioeconomic characteristics, risk factor prevalence and physician density.
After full adjustment, HF-related mortality rates remained higher in rural counties compared with urban counties in younger adults (IRR = 1.1; 95% CI, 1.04-1.16) and in older adults (RR = 1.04; 95% CI, 1.02-1.07).
“Over the past decade, rural counties have experienced disproportionate rates of hospital closures, and in the 6 years following a hospital closure, rural counties experienced an 8.2% decrease in both primary care physicians and medical specialists,” the researchers wrote. “Expansion of Medicaid coverage may be a viable health policy intervention to target HF-related mortality rates, as rates of hospital closure have been lower in states that expanded Medicaid in part due to uninsured patients gaining Medicaid coverage, particularly in rural counties. It will be important for future studies to investigate local changes in HF-related mortality rates following these drastic shifts in access to health insurance, physicians and hospital care, particularly among rural communities.”
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