Recent findings indicate a troubling rise in cardiovascular disease-related deaths among rural populations in the United States, particularly among individuals under 65 years old. This trend emerged following the COVID-19 pandemic and is highlighted in a study set to be shared at the American Heart Association’s Scientific Sessions event in Chicago. The study reveals that residents in rural areas continue to experience higher rates of cardiovascular-related fatalities compared to those living in urban settings, which points to a significant public health crisis within rural America, according to lead researcher Dr. Lucas X. Marinacci.
Dr. Marinacci emphasizes the urgent need to address factors contributing to this situation, including rural poverty, limited health insurance coverage, and a lack of awareness surrounding the prevention and management of obesity and diabetes, which are closely linked to cardiovascular issues. “This is a call to action,” stated Marinacci, who is a cardiology fellow at Beth Israel Deaconess Medical Center, affiliated with Harvard Medical School.
Even before the pandemic’s onset, rural Americans exhibited higher mortality rates from cardiovascular diseases. Key contributors to this trend include higher poverty levels, increased smoking rates, and elevated instances of obesity and hypertension compared to urban counterparts. Additionally, rural residents, numbering approximately 66 million according to census data, often find accessing healthcare services difficult due to distance, transportation challenges, and inadequate insurance coverage.
Dr. Marinacci noted that the increase in obesity among younger demographics, including children and teenagers, is a national concern that often affects rural regions disproportionately. Adults aged 40 to 59 have notably high severe obesity rates, which may be contributing to the uptick in cardiovascular deaths among those aged 25 to 64.
During the pandemic, many individuals delayed necessary healthcare visits, resulting in untreated risk factors such as diabetes and hypertension. Furthermore, rural communities experienced a notable rise in “diseases of despair,” including substance abuse and depression, which can further exacerbate cardiovascular issues. These combined factors, worsened by the pandemic, may have rendered rural adults more vulnerable to both the direct and indirect cardiovascular repercussions of COVID-19.
The study, which is also available in the Journal of the American College of Cardiology, evaluated federal death statistics from over 11 million adults who died from cardiovascular conditions between 2010 and 2022. Before the pandemic, cardiovascular death rates were decreasing across all populations. However, from 2020 onwards, the trend reversed, leaving rural populations in a worse health situation by 2022 compared to 2010. Specifically, rural residents suffered an increase of 3.4 deaths per 100,000 people, while urban areas saw a notable decrease, with nearly 24 fewer deaths per 100,000 people.
The differences in cardiovascular death rates were even more pronounced among specific age groups. By 2022, individuals aged 25 to 64 in rural areas experienced a 21% increase in cardiovascular death rates compared to 2010, while their counterparts in metropolitan areas had a mere 3% rise. Interestingly, older adults (65 and above) showed improvements in mortality rates, with rural areas seeing a 4.4% decline and urban areas an 8.5% decrease.
However, the study has its limitations, including potential inaccuracies in death certificate data and a lack of information regarding individuals’ residential status prior to their passing. Dr. Bala Simon, the deputy chief medical officer for the Arkansas Department of Health, expressed that these findings resonate with the challenges faced in his predominantly rural state, where a significant percentage of adults struggle with obesity.
In Arkansas, many individuals resort to fast food or convenience stores for meals, as these options are often more accessible than grocery stores offering healthier produce. According to Dr. Simon, the pandemic’s impact on those under 65—a demographic that has been raised in a fast-food culture—has been significantly detrimental. He explains that cardiovascular disease is a long-term process and stresses the importance of enhancing public health messaging to promote healthy eating, physical activity, and adequate sleep. Such measures could greatly improve cardiovascular health and potentially offer better protection in future health crises.