A wide variation in cardiovascular disease mortality rates has been noted among counties in the United States. Residents of rural areas have higher mortality rates than residents of urban areas, particularly from potentially preventable causes.
A recent study published in The Journal of the American Medical Association (JAMA), analyzed the trends in cardiovascular disease in rural and urban areas, across different subgroups in the United States.
The study looked at data between the years 1999 to 2017 and found a higher prevalence of age-adjusted cardiovascular mortality occurred in rural areas compared with metropolitan areas, regardless of the subgroup. Although deaths from cardiovascular disease have been declining overall, the rate of decline in rural areas is slower.
The authors of the study took data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database to assess the differences in age-adjusted cardiovascular disease mortality for:
- large metropolitan areas, with at least 1 million residents
- medium and small metropolitan areas with 50,000 – 999,999 residents
- rural areas with less than 50,000 residents
The authors found the age-adjusted cardiovascular disease-related mortality rates per 100,000 people per year were:
|
Year |
Large Metro. |
Medium/Small Metro. |
Rural |
|---|---|---|---|
|
1999 |
347.6 |
343.7 |
371.6 |
|
2011 |
219.3 |
228.4 |
258.1 |
|
2017 |
208.6 |
221.8 |
251.4 |
|
Years |
Large Metro. |
Medium/Small Metro. |
Rural |
|---|---|---|---|
|
1999 – 2011 |
4.1% |
3.7% |
3.2% |
|
2011 – 2017 |
0.7% |
0.5% |
0.3% |
The study concluded that cardiovascular disease, in conjunction with drug overdose and suicide, may contribute to people's reduced life span in medium and small metropolitan and rural areas. The authors claim that the differences between rural and metropolitan regions may be attributed to "demographic changes, the economic slowdown, the high prevalence of cardiovascular disease risk factors, and poorer access to health care."
Haider J. Warraich, MD who was an author on the paper, said:
"Risk factors for [cardio vascular disease], such as high [blood pressure], diabetes, obesity, smoking and lack of exercise, are all more common in rural Americans than they are in urban areas. That may surprise some people because when we think of rural America, we think of lots of space and access to potentially better nutrition, but over time we've exported a lot of our bad habits from big cities into smaller towns. This is an indictment of the rural health system and rural hospitals. The rural health system was developed after World War II. Thousands of hospitals were built, and the focus was on acute conditions. But when it comes to the management of chronic conditions like heart disease, high [blood pressure], and diabetes, we just don't have much of a framework to help patients."