Half of US counties, mostly rural, lack any cardiologists
Click Here to Manage Email Alerts
Key takeaways:
- Almost half of all U.S. counties have no cardiologists, affecting 22 million Americans.
- Nearly all counties without cardiologists were rural, with an average round-trip distance to one of 87 miles.
Nearly half of U.S. counties lack cardiologists, almost all of which are rural, with lower household income and higher prevalence of CV risk factors, according to a research letter published in the Journal of the American College of Cardiology.
“While cardiologists are not the only determinants of cardiovascular outcomes, the lack of access to cardiologists in areas with greater prevalence of heart disease and mortality is incredibly concerning,” Haider J. Warraich, MD, director of the heart failure program at VA Boston Healthcare and associate physician at Brigham and Women’s Hospital, said in a press release. “Our findings really highlight the critical need to find ways to mitigate deep disparities to improve cardiovascular disease outcomes for Americans living in rural and disadvantaged areas.
“Policy reforms, such as financial incentives to clinicians to practice in areas with marginal access or better leveraging telemedicine are potential options,” he said in the release. “The integration and coordination of cardiovascular care — especially with regard to prevention and risk modification — with the primary care is crucial.”
For their study, Warraich, Jeong Hwan Kim, MD, a heart failure cardiologist at Brigham and Women’s Hospital and VA Boston Healthcare, and colleagues utilized the HealthLink Dimensions database to estimate county-level access to cardiologists in the U.S.
The county-level access data were cross-referenced with population estimates of race/ethnicity, urban/rural data from the 2020 U.S. Census, median household income, percentage of uninsured people, food environment index, life expectancy and a composite CV index determined by prevalence of risk factors in the CDC PLACES database.
Among 3,143 U.S. counties, 46.3% had no cardiologists (86.2% rural), affecting 22 million residents.
The remaining counties had an average of 24 cardiologists each.
The average round-trip distance to the nearest cardiologist was 16.3 miles in counties with a cardiologist compared with 87.1 miles in counties without cardiologists, the researchers wrote.
Counties without cardiologists had a 31% higher CV risk index, prevalence of all risk factors and age-adjusted CV mortality, compared with counties with cardiologists.
Lower household income, uninsured status and poor access to healthy food and primary care physicians were all more prevalent in counties without cardiologists, according to the researchers.
Moreover, Native Americans had the highest likelihood compared with all other racial/ethnic groups studied of living in a county without cardiologists.
“The findings of this study are both enlightening and alarming, shedding light on the severe geographic disparities in access to cardiovascular care across the United States,” Harlan M. Krumholz, MD, SM, FACC, Harold H. Hines, Jr. Professor of Medicine at the Yale School of Medicine, director of the Yale New Haven Hospital Center for Outcomes Research and Evaluation and editor-in-chief of JACC, said in the release. “This study underscores the urgent need for policy reforms and innovative solutions, such as financial incentives for clinicians and the expanded use of telemedicine, to bridge this gap. Ensuring equitable access to cardiovascular care is a crucial step towards improving overall public health outcomes and reducing preventable cardiovascular mortality.”
Reference:
- Almost half of US counties have no cardiologists despite higher prevalence of CV risk factors, mortality. https://www.eurekalert.org/news-releases/1050246.Published July 8, 2024. Accessed July 8, 2024.
Collapse
Read more about
Click Here to Manage Email Alerts