Study: Deaths from cardiovascular disease surge among adults 25-64 in rural areas
NEW YORK, Nov. 11 (UPI) - Deaths from cardiovascular disease have surged among adults ages 25 to 64 living in rural areas, a new study shows.
The study - which was to be presented Sunday at the American Heart Association Scientific Sessions 2024 in Chicago - appeared Monday in the Journal of the American College of Cardiology.
These findings underscore a pressing demand to tackle increasing disparities in rural versus urban areas, researchers noted.
"Our findings suggest that targeted policy efforts to improve the cardiovascular health in rural areas, especially among younger age groups, are urgently needed now more than ever," the study's lead author, Dr. Lucas Xavier Marinacci, told UPI.
"These efforts should take into account important social determinants of health, such as poverty, education and insurance coverage," said Marinacci, a fellow in cardiovascular medicine at Beth Israel Deaconess Medical Center in Boston, a teaching hospital of Harvard Medical School.
It's imperative to support initiatives that expand the rural healthcare workforce, keep hospitals open in those areas and help build the local economy, he said.
The researchers, who analyzed death certificate data for more than 11 million U.S. adults from 2010 to 2022, found that cardiovascular disease death rates increased by about 21% for adults ages 25 to 64 who live in rural areas.
Meanwhile, they determined that the rates decreased by about 9% for adults ages 65 or older who live in urban areas.
Researchers obtained this information from a database of the Centers for Disease Control and Prevention.
After the onset of the COVID-19 pandemic in 2020, cardiovascular death rates increased much more in rural areas compared to urban locations, researchers said, noting that this finding held steady across all ages.
"Prior research has demonstrated that adults in rural communities are more likely to die from cardiovascular disease than their urban counterparts," Marinacci said.
"The cause of the surge in cardiovascular deaths among younger adults - predominantly concentrated in rural areas - is concerning and requires further research. One potential explanation is a rise in the burden of cardiometabolic risk factors combined with worsening socioeconomic conditions."
These risk factors include high waist circumference and elevated blood sugar, cholesterol and blood pressure. They may have become worse in rural America leading up to the COVID-19 pandemic, Marinacci noted.
"Then, the pandemic itself created massive disruption in care and an unprecedented surge in psychosocial stressors that disproportionately impacted rural populations," he said.
"At the same time, pandemic relief efforts allocated billions of dollars to bolstering rural health and reducing poverty nationwide."
Given all these changes, "we wanted to evaluate how the rural-urban disparities in cardiovascular mortality changed between 2012-2022 both overall, as well as before and after the pandemic onset," he said.
Other experts said it's alarming that rural areas are falling farther behind in cardiovascular outcomes, especially among younger people.
Dr. Karen Joynt Maddox, a cardiologist and an associate professor at Washington University School of Medicine in St. Louis, said these outcomes are more dismal in rural areas with high poverty rates and those with a high proportion of minorities. She was not involved in the study.
"This is a timely and well-done study that addresses a crucial question: Are we making progress in closing these important urban-rural gaps in cardiovascular outcomes?" Maddox said, adding that "we need redoubled efforts to understand what's driving these differences, as well as new solutions to try to address them."
Cardiovascular risk factors such as diabetes, hypertension and obesity are more prevalent among rural adults, said Dr. Laxmi Mehta, director of preventative cardiology and women's cardiovascular health at The Ohio State University Wexner Medical Center in Columbus.
Other variables that contribute to higher cardiovascular death rates include depression, suicide and substance use, along with limited access to quality health care and specialized services for rural patients, said Mehta, who is a clinical professor of internal medicine in the Division of Cardiovascular Medicine.
"This highlights the need to provide whole person care for our patients to truly make a difference in their cardiovascular mortality," she said, emphasizing smoking cessation, increased physical activity and a healthy diet.
Historically, there has been a lack of investment in rural health research, but that has changed in recent years, with funding from private organizations and the U.S. government, said Dr. Chris Longenecker, a professor and director of the Global Cardiovascular Health Program at the University of Washington School of Medicine in Seattle.
However, this effort should involve partnerships between academic medical centers and rural communities, which would include residents' perspectives, said Longenecker, principal investigator of the university's Rural PRO-CARE Health Equity Research Network.
"Community engaged research is hard, but it's what is needed to improve these disparities," he said.
