Study: Deaths from cardiovascular disease are increasing among adults ages 25 to 64 in rural areas

These findings underscore the urgent need to address increasing disparities between rural and urban areas, the researchers noted.

“Our findings suggest that targeted policy efforts to improve cardiovascular health in rural areas, particularly among younger age groups, are needed now more than ever,” said the study's lead author, Dr. Lucas Xavier Marinacci, told UPI.

“These efforts should address 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 is essential to support initiatives that expand the rural health workforce, keep hospitals in those areas open and help build local economies, he said.

The researchers, who analyzed death certificate data for more than 11 million U.S. adults from 2010 to 2022, found that mortality rates from cardiovascular disease among adults ages 25 to 64 living in rural areas increased by about 21% increase.

Meanwhile, they found that rates fell by about 9% among adults aged 65 and older living in urban areas.

The researchers obtained this information from a database at the Centers for Disease Control and Prevention.

After the outbreak of the COVID-19 pandemic in 2020, cardiovascular death rates increased much more in rural areas than in urban areas, researchers said, noting that this finding remained consistent across all age groups.

“Previous research has shown that adults in rural communities are more likely to die from cardiovascular disease than their urban counterparts,” Marinacci said.

“The cause of the increase in cardiovascular deaths among younger adults – predominantly in rural areas – is concerning and requires further research. One possible explanation is an increase in the burden of cardiometabolic risk factors coupled with worsening socioeconomic conditions.”

These risk factors include a high waist circumference and elevated blood sugar, cholesterol and blood pressure. They may have gotten worse in rural America in the lead-up to the COVID-19 pandemic, Marinacci noted.

“Then the pandemic itself led to massive disruptions in care and an unprecedented rise in psychosocial stressors that disproportionately affected rural populations,” he said.

“At the same time, the pandemic relief effort has provided billions of dollars to improve rural health and reduce poverty nationwide.”

Given all these changes, “we wanted to assess how rural-urban differences in cardiovascular mortality changed between 2012 and 2022, both overall and before and after the onset of the pandemic,” he said.

Other experts said it was alarming that rural areas were falling further behind in cardiovascular outcomes, particularly among younger people.

Dr. Karen Joynt Maddox, a cardiologist and associate professor at Washington University School of Medicine in St. Louis, said these results are bleaker in rural areas with high poverty rates and high minority populations. She was not involved in the study.

“This is a timely and well-conducted study that addresses a critical question: Are we making progress in closing these important urban-rural gaps in cardiovascular outcomes?” Maddox said, adding: “We need increased efforts to to understand what causes these disparities and new solutions to address them.”

Cardiovascular risk factors such as diabetes, high blood pressure and obesity are more common in rural adults, Dr. Laxmi Mehta, director of preventive cardiology and women's cardiovascular health at The Ohio State University Wexner Medical Center in Columbus.

Other variables that contribute to higher cardiovascular mortality rates include depression, suicide and substance use, as well as limited access to quality health care and specialized services for rural patients, said Mehta, clinical professor of internal medicine in the Division of Cardiovascular Medicine.

“This highlights the need for holistic care for our patients to truly reduce 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, Dr. Chris Longenecker, professor and director of the Global Cardiovascular Health Program at the University of Washington School of Medicine in Seattle.

But those efforts should include partnerships between academic medical centers and rural communities that would incorporate residents' perspectives, said Longenecker, principal investigator of the university's Rural PRO-CARE Health Equity Research Network.

“Community-focused research is difficult, but it is necessary to address these disparities,” he said.