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Rural U.S. has more heart failure deaths than urban areas

Greatest increases are in Black men under 65 years old

CHICAGO --- Heart failure deaths are persistently higher in rural areas of the United States compared with urban areas, reports a new Northwestern Medicine study. The research also showed race disparities in heart failure are prevalent in rural and urban areas with greatest increases among Black adults under 65 years old.

Heart failure deaths have been increasing nationally since 2011, but there is significant geographic variation in these patterns based on race.

“This work demonstrates a persistent and troubling rural disadvantage with significantly higher rates of death in rural areas compared with urban areas,” said lead study author Dr. Sadiya Khan, an assistant professor of medicine at Northwestern University Feinberg School of Medicine and a Northwestern Medicine cardiologist.

The study was published in the journal PLOS ONE this month.

Possible factors for the disparities are higher levels of adverse social factors (e.g., lower income), risk factors such as obesity and diabetes in rural areas and fewer physicians, specifically cardiologists.

“Research is needed to identify barriers and define best strategies to prevent heart failure and optimize guideline-directed medical therapies, once heart failure develops,” Khan said.

This is the first study that:

  • Focuses on geographic heterogeneity in heart failure mortality rates by rural or urban area
  • Demonstrates patterns of heart failure mortality are changing unfavorably with increases since 2011 in both rural and urban areas; these increases are greater among younger adults under age 65 years with greatest increases among Black men younger than 65. 

The study used national death certificate data from the Centers for Disease Control that capture all deaths that occur in the U.S. Investigators identified cardiovascular deaths related to heart failure that occurred since 2011 and calculated annual age-adjusted mortality rates and trends in rural and urban areas, overall, by age groups and by race and sex.

Other Northwestern authors include Jacob Pierce, Nilay Shah, Lucia Petito, Lindsay Pool, Dr. Donald M. Lloyd-Jones and Joe Feinglass.

This work was supported by grants from National Institutes of Health's National Center for Advancing Translational Sciences Grant Number KL2TR001424 and the American Heart Association.