For low-income residents, rurality predominantly affects HF risk in women and Black men
Among low-income participants, rural living was independently associated with increased risk for HF among Black men and Black and white women, but not among white men, according to a study published in JAMA Cardiology.
“Rural populations experience a disproportionate burden of HF mortality, compounded by racial inequities,” Sarah E. Turecamo, BA, of the division of intramural research, epidemiology and community health branch of the NHLBI/NIH, and colleagues wrote. “Black men living in rural areas, particularly the rural South, are more likely to die of HF compared with Black men in urban areas and White men in both rural and urban areas. Whether these inequities reflect higher HF incidence is less understood. Addressing this question is critical to develop interventions to reduce rural-urban disparities.”
Data were derived from Turecamo SE, et al. JAMA Cardiol. 2023;doi:10.1001/jamacardio.2022.5211.
To this end, Turecamo and colleagues utilized data from the population-based Southern Community Cohort Study (SCCS) to identify 27,115 Black and white participants without HF at baseline and received care from CMS (median age, 54 years; 63% women; 69% Black). SCCS enrolled low-income participants from 12 states across the southeastern U.S. between 2002 and 2009 and follow-up was conducted through 2016.
Quartiles of neighborhood deprivation index score were fairly evenly distributed throughout the present cohort and 20% of participants resided in rural areas. Urban participants were slightly more likely to live in neighborhoods with a higher level of deprivation, according to the study.
During a median 13 years of follow-up, researchers observed an HF incidence of 29.6 per 1,000 person-years among urban SCCS participants (95% CI, 28.9-30.5) and 36.5 per 1,000 person-years for rural participants (95% CI, 34.9-38.3; P < .001).
After adjustment for demographics, CV risk factors, health behaviors and socioeconomic factors, risk for incident HF was approximately 19% greater among rural participants compared with urban participants (HR = 1.19; 95% CI, 1.13-1.26).
Moreover, rurality-associated HF risk was especially elevated among Black men (HR = 1.34; 95% CI, 1.19-1.51), Black women (HR = 1.18; 95% CI, 1.08-1.28) and white women (HR = 1.22; 95% CI, 1.07-1.39); however, researchers observed no increased risk among rural-living white men (HR = 0.97; 95% CI, 0.81-1.16). Additional adjustment for neighborhood deprivation index score, enrollment source, insurance coverage or inclusion of other racial/ethnic groups failed to attenuate the association between rurality and HF risk, according to the study.
“Our results resonate with the call for primary prevention as a strategy to reduce HF health inequities ... and provide important practical strategies to do so,” the researchers wrote. “Our hypothesis-generating results suggest a need to personalize prevention, focusing on rural women and rural Black men as key groups, and to elucidate the mechanism by which rurality is associated with HF risk.”
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