Cardiovascular disease deaths rising among younger adults living in rural areas
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Key takeaways:
- Years of declining CV mortality reversed and increased amid the pandemic, particularly in rural U.S. communities.
- Rates increased even more for younger rural-living adults.
CHICAGO — The rate of deaths from CVD increased in rural areas and decreased in urban areas of the U.S. from 2010 to 2022, and the difference was especially pronounced amid the COVID-19 pandemic and among younger adults, researchers reported.
“Rural areas in the U.S. have long had higher CV mortality than urban areas, due to both higher risk factors and social determinants like access to care, poverty and education. We were concerned that the pandemic, which hit rural communities harder, in both direct health impacts and disruptions to care, may have further worsened these disparities,” Lucas X. Marinacci, MD, a cardiology fellow at Beth Israel Deaconess Medical Center and a postdoctoral research fellow under the mentorship of Rishi Wadhera, MD, MPP, MPhil, associate professor of medicine at Harvard Medical School and Beth Israel Deaconess Medical, told Healio. “However, COVID-19 relief funding directed at rural health might have helped mitigate some of the impact. This motivated us to evaluate contemporary trends in rural-urban differences in CV mortality both leading up to and after the onset of the pandemic.”
The results of the study were presented at the at the American Heart Association Scientific Sessions and published in the Journal of the American College of Cardiology.
Marinacci and colleagues used the CDC WONDER database to identify deaths in the U.S. from 2010 to 2022.
From 2010 to 2022, more than 11 million CV deaths occurred in the U.S., of which 5.4 million were in urban areas, 3.4 million in small/medium metropolitan areas and 2.1 million in rural areas.
From 2010 to 2022, the rate of age-adjusted CV mortality increased in rural areas from 431.6 to 435 per 100,000 population (95% CI, 0.4-6.4), with an annual increase of 0.1% per year (95% CI, 0.3 to 0.6).
The researchers reported a similar tends in small/ medium metropolitan areas compared with rural areas, according to the presentation.
However, the rate of age-adjusted CV mortality decreased in urban areas from 369.3 to 345.5 per 100,000 population (95% CI, 25.3 to 22.2) during this period, with an annual decrease of 0.2% per year (95% CI, 0.5 to 0).
From 2010 to 2019, the rate of age-adjusted CV mortality declined, on average, 0.7% each year overall in rural areas, 0.6% in small/medium metropolitan areas and 0.8% in urban areas. But age-adjusted CV mortality rates increased 1% per year among younger adults living in rural areas; this was not observed among younger urban-living adults or older subgroups.
By 2022, rural-living adults had higher relative risk for CV mortality compared with urban-living adults (RR = 1.53; 95% CI, 1.41-1.65; P < .001), a finding the researchers said was partially attenuated after adjusting for community poverty, educational attainment and uninsured rates (RR = 1.25; 95% CI, 1.14-1.35; P < .001).
“Rising obesity in the U.S., especially among younger, rural populations, may have led to a deterioration in cardiometabolic health that made them more vulnerable to pandemic-related stresses, including COVID-19’s CV effects. Also, unlike older adults, who have access to Medicare, younger rural adults are more likely to be uninsured, particularly in states that didn’t expand Medicaid under the Affordable Care Act,” Marinacci told Healio. “So younger rural adults may have been more severely affected by the disruptions in health care access, financial strain and ‘diseases of despair’ created by the pandemic — which are all tied to worse CV outcomes.”
Additionally, the observed decline in the overall rate of age-adjusted CV mortality reversed in rural areas from 2019 to 2022, and increased, on average, 3.1% per year. The researchers also reported increases in urban areas, but these increases were smaller by comparison (1.2%), widening the reported disparities in rural CV death (P for differential change in age-adjusted CV mortality < .001).
“Rising CV mortality in rural areas, especially among younger adults, requires urgent policy action. Strengthening rural health care, public health efforts and addressing socioeconomic issues like insurance, education and poverty are critical to improving long-term CV health in these communities,” Marinacci said.
Marinacci said that because this research relied on cause-of-death reports on individuals’ death certificates, it is possible that rural and urban areas classified deaths differently during the pandemic, which may partially explain the rural increase.
References:
- Deaths from cardiovascular disease increased among younger U.S adults in rural areas. https://newsroom.heart.org/news/deaths-from-cardiovascular-disease-increased-among-younger-u-s-adults-in-rural-areas. Published Nov. 11, 2024. Accessed Nov. 13, 2024.
- Marinacci LX, et al. J Am Coll Cardiol. 2024;doi:10.1016/j.jacc.2024.09.1215.
- Rural Residents More Likely to Die From Heart Disease Than Urban Residents. https://www.acc.org/About-ACC/Press-Releases/2024/11/12/16/40/Rural-Residents-More-Likely-to-Die-From-Heart-Disease-Than-Urban-Residents. Published Nov. 12, 2024. Accessed Nov. 13, 2024.
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Marinacci LX, et al. Moderated Digital Poster 1058. Presented at: American Heart Association Scientific Sessions; Nov. 16-18, 2024; Chicago.
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