Adults living in rural areas of the United States have a 19% higher risk of developing heart failure compared to their urban counterparts, and black men living in rural areas have a particularly higher risk — 34%, according to a large observational study. study supported by the National Institutes of Health.
The study, one of the first to look at the link between living in rural America and first-time heart failure, highlights the importance of developing more tailored approaches to heart failure prevention among rural residents, particularly black men. The study was funded in large part by the National Heart, Lung and Blood Institute (NHLBI), part of NIH, and the findings, produced in collaboration with Vanderbilt University Medical Center, Nashville, Tenn., are published today in JAMA Cardiology.
We did not expect to find a difference of this magnitude in heart failure between rural communities compared to urban communities, especially among black men living in rural areas. This study makes it clear that we need tools or interventions specifically designed to prevent heart failure in rural populations, particularly black men living in these areas.”
Véronique L. Roger, MD, MPH, corresponding author of the study and senior investigator in the Epidemiology and Community Health Branch in NHLBI’s Division of Intramural Research
Study co-author Sarah Turecamo, a fourth-year medical student at New York University Grossman School of Medicine, New York City, and part of the NIH Medical Research Scholars Program, agreed. “It’s much easier to prevent heart failure than to reduce mortality once you have it,” Turecamo said.
Researchers from NHLBI and Vanderbilt University Medical Center analyzed data from The Southern Community Cohort Study, a long-term study of adult health in the southeastern United States. They compared the rates of new onset heart failure among rural and urban residents in 12 states (Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, and West Virginia). The population, which included 27,115 adults without heart failure at enrollment, was followed for approximately 13 years. Almost 20% of the participants lived in rural areas; the rest lived in urban areas. Nearly 69% were black adults recruited from community health centers that care for medically underserved populations.
At the end of the study period, the researchers found that living in rural America was associated with an increased risk of heart failure in both women and black men, even after adjusting for other cardiovascular risk factors and socioeconomic status. Overall, the risk of heart failure was about 19% higher in rural residents than their urban counterparts. However, black men living in rural areas had the highest risk of all: a 34% higher risk of heart failure compared to black men living in the city.
The study found that white women living in rural areas had a 22% higher risk of heart failure compared to white women living in urban areas, and black women had an 18% higher risk compared to black women living in urban areas. No association was found between living in rural areas and the risk of heart failure in white men.
The exact reasons behind these health disparities between rural and urban areas are unclear and are still under investigation. Researchers said there could be a host of factors at play, including structural racism, unequal access to health care and a shortage of supermarkets that offer affordable and healthy food.
“Finding a link between rural living and an increased incidence of heart failure is an important advance, especially given its implications for helping address geographic, gender, and race-based disparities,” says David Goff, MD, Ph. D., director of NHLBI’s Department of Cardiovascular Sciences. “We look forward to future studies testing interventions to prevent heart failure in rural populations as we continue to fight heart disease, the leading cause of death in the US”
Heart failure is a chronic and progressive condition that develops when the heart does not pump enough blood for the body’s needs. Common symptoms include shortness of breath during daily activities or difficulty breathing while lying down. The condition, which has few treatment options, affects approximately 6.2 million American adults.
Heart failure can be prevented by following a heart-healthy lifestyle. Roger from NHLBI, who is also a practicing cardiologist, noted that one of the biggest causes of heart failure is hypertension, or high blood pressure, which black men experience at disproportionately high levels. The condition must be managed intensively by regularly monitoring blood pressure and taking medications as directed. Other ways to reduce the risk of heart failure include avoiding all forms of tobacco, eating a healthy diet, and exercising.
Research reported in this study was funded by the NIH Medical Research Scholars Program, a public-private partnership jointly supported by NIH and contributions to the Foundation for the NIH. The research was also supported by the NHLBI’s Division of Intramural Research, the NHLBI Training Award in Cardiovascular Research (T32 367 HL007411), the Intramural Research Program of the National Institute on Minority Health and Health Disparities, the National Cancer Institute (grants R01 CA092447 and 368 U01 CA202979), and additional funding from the American Recovery and Reinvestment Act (3R01 CA 029447-0851). The Southern Community Cohort Study is funded by the National Cancer Institute. See the published journal article for a full list of financial aid.
National Health Institutes
Turecamo, SE, et al. (2023) Association of rurality with heart failure risk. JAMA Cardiology. doi.org/10.1001/jamacardio.2022.5211.