Adults living in rural areas of the United States have a 19% higher risk of developing heart failure compared to their urban counterparts, and black men living in rural areas have an especially higher risk – 34%, according to a large observational study supported by the National Institutes of Health.
The study, one of the first to look at the link between living in rural America and first-time cases of heart failure, underscores the importance of developing more customized approaches to heart failure prevention among rural residents, particularly black men. The study was largely funded by the National Heart, Lung, and Blood Institute (NHLBI), part of NIH, and the findings, produced in collaboration with Vanderbilt University Medical Center, Nashville, Tennessee, were published today in JAMA Cardiology.
Researchers from NHLBI and Vanderbilt University Medical Center analyzed data from The Southern Community Cohort Study, a long-term health study of adults in the southeastern United States. They compared the rates of new onset heart failure among rural and urban residents in 12 states (Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, and West Virginia). The population, which included 27,115 adults without heart failure at enrollment, were followed for about 13 years. Nearly 20% of participants lived in rural areas; the remainder lived in urban areas. Almost 69% were black adults recruited from community health centers that care for medically underserved populations.
At the end of the study period, the researchers found that living in rural America was associated with an increased risk of heart failure among both women and black men, even after adjustment for other cardiovascular risk factors and socioeconomic status. Overall, the risk of heart failure was about 19% higher in rural residents than their urban counterparts. However, black men living in rural areas had the highest risk of all — a 34% higher risk of heart failure compared to urban-dwelling black men.
The study showed white women living in rural areas had a 22% increased risk of heart failure compared to white women in urban areas, and black women had an 18% higher risk compared to black women in urban areas. No association was found between rural living and heart failure risk among white men.
The exact reasons behind these rural-urban health disparities are unclear and are still being explored. Researchers said a multitude of factors may be at play, including structural racism, inequities in access to healthcare, and a dearth of grocery stores that provide affordable and healthy foods, among others.
