Death from heart disease more common in rural areas—what can cardiologists do?
Patient data continue to underscore a growing health crisis in rural America, where residents are significantly more likely to die from cardiovascular disease than their urban counterparts.
A key article on this trend, published in full in the Journal of the American College of Cardiology (JACC), reveals that while cardiovascular mortality was steadily declining nationwide from 2010 to 2019, the COVID-19 pandemic reversed that progress.[1]
"Cardiovascular mortality was declining in rural and urban areas between 2010 and 2019. But the pandemic basically wiped away all that progress, and we saw reversal in these trends and a big increase in cardiovascular mortality in rural areas. There was also an increase in urban areas, but much smaller. So disparities widened," explained lead author Rishi Wadhera, MD, MPP, MPhil, associate director of the Richard A. and Susan F. Smith Center for Outcomes Research at Beth Israel Deaconess Medical Center and associate professor of medicine at Harvard Medical School. He spoke to Cardiovascular Business about the study and overall data trends from other studies in the above video interview.
"One thing that's been very surprising when you look at all the data over the last decade or so is, much of the widening and rural urban disparities and heart-related deaths have been driven by young, rural adults, age 25 to 64 years, who have experienced a 20% rise in cardiovascular mortality since 2010. And I think we should be worried about that," he said.
Wadhera attributes this rise to both structural healthcare barriers and a rise in so-called "diseases of despair," which include substance use, depression and suicide.
The ACC issued a public statement alongside the study, emphasizing the urgent need for action. The findings serve as a call to arms for both policymakers and healthcare professionals to address a deepening rural-urban health divide.
Solutions to resolve rural vs. urban healthcare inequities
Wadhera said there are a few things cardiologists and policy makers need to think about if they are serious about improving cardiovascular health for rural Americans, including access to care and various social issues.
"There has been a big focus on healthcare access, which I think is very, very important. How do we ensure that rural Americans have equitable access to healthcare? And I think telehealth has been a big part of that story and could be a very valuable tool to bridge this access gap that we see between rural and urban Americans," Wadhera explained.
Telehealth exploded during the pandemic, but he said it actually exploded more in urban areas than in rural areas. So there is a need for focused strategies backed by government policies to really get rural Americans access to more telehealth services.
"Access is only one part of the story. The second thing we need to think about is how we're going to fix worsening socioeconomic conditions in rural communities. And that's a much bigger issue and challenge, which will require federal and state level interventions. Do we need to bolster the safety net and what welfare programs? How are we going to address food insecurity and housing instability in these communities, in addition to addressing the healthcare access?" Wadhera asks.
As rural hospitals have been closing across the country at an alarming rate, and economic hardship deepens in these rural regions, the healthcare inequities divide continue to widen. The study paints a stark picture of the urgent need for cross-sector solutions to improve cardiovascular health and overall wellbeing in rural America.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]