In the post-pandemic U.S., cardiovascular death rates are 1.5 times higher in rural areas compared with urban areas, a brief report shows, and socioeconomic factors are the most significant cause for these outcomes. Lucas X. Marinacci, MD, of Beth Israel Deaconess Medical Center, Boston, and colleagues, reported these results Tuesday online in the Journal of the American College of Cardiology. Rural communities in the U.S. have higher rates of myocardial infarction, heart failure, diabetes, obesity and stroke — all risk factors for cardiovascular diseases. Research performed prior to the COVID-19 pandemic revealed a concerning, growing gap in cardiovascular mortality rates between rural and urban areas in the U.S. The pandemic created several disruptions, heightened in rural communities, that may have expanded this gap. Investigators in this study utilized national death data from 2010 to 2022 from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research Database. The International Classification of Diseases-10th Revision was used to define cardiovascular deaths. Patient data was divided into three groups: urban (population ≥1 million), small/medium metropolitan (50,000-999,999) or rural (<50,000). Age-adjusted cardiovascular mortality rates (AAMRs) per 100,000 population were assessed. Stratified analyses by age (25-64 years and ≥65 years) and sex were also performed. A total of 11,017,255 occurred between 2010 and 2022: 5,452,636 urban; 3,416,996 metropolitan and 2,102,623 rural. Rural areas had the greatest number of AAMRs across the board. Rural AAMR rates increased from 431.6 to 435.0 per 100,000 (95% confidence interval [CI]=0.4-6.4 per 100,000). Trends were similar in metropolitan areas. However, AAMR rates decreased in urban locations (369.3 to 345.3 per 100,000; 95% CI: -0.5%-0.0%). This resulted in a larger gap between rural AAMR rates and urban AAMR rates (p for differential change in AAMR <0.001). These results were especially prevalent in younger rural adults aged 25-64 years (95% CI=111.0-134.2 per 100,000; +23.2 per 100,000). Significant declines in AAMRs were observed in older adults aged ≥65 years in all areas, but the decline rates were still larger in urban areas compared with rural areas. Between 2010-2019, AAMRs declined in rural, metropolitan and urban areas, but younger rural adults experienced an increase in AAMRs during this time (111.0 to 119.1 per 100,000; 95% CI=30.5-36.2 per 100,000). Around the pandemic, 2019-2022, this overall AAMR decline reversed in rural areas (401.6 to 435 per 100,000) and similar, but lower, rates of AAMR were seen in urban areas between 2019 and 2022 (333.4 to 345.5 per 100,000). The rural-disparities gap grew during this time. Overall, rural communities in the US are burdened by more social, economic and health system challenges, along with other risk factors that contribute to higher rates of cardiovascular mortality, compared with urban areas. This cardiovascular mortality gap was expanded by the COVID-19 pandemic. Source: Marinacci, LX, Zheng Z, Mein S, et al. Rural-urban differences in cardiovascular mortality in the United States, 2010-2022. J Am Coll Cardiol. 2024 Nov 12 (Article in press). Image Credit: Nick Fox – stock.adobe.com