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 supported by the National Institutes of Health.
The study, one of the first to examine the link between living in rural America and early cases of heart failure, underscores the importance of developing more personalized approaches to preventing heart failure in rural residents, especially black men. The study was largely funded by the National Heart, Lung, and Blood Institute (NHLBI), part of the NIH, and the results, produced in collaboration with Vanderbilt University Medical Center, 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,” said Véronique L. Roger, MD, MPH , corresponding author of the study and principal investigator. with the Epidemiology and Community Health Branch of the NHLBI Division of Intramural Research. “This study clearly shows that we need tools or interventions specifically designed to prevent heart failure in rural populations, especially among black men living in these areas.”
Study co-author Sarah Turecamo, a fourth-year medical student at New York University’s Grossman School of Medicine in New York City and part of the NIH Medical Research Scholars Program, agreed. “It’s much easier to prevent heart failure than to reduce its 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 rates of new heart failure among rural and urban residents of 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 participants lived in rural areas; the rest lived in urban areas. Nearly 69% were black adults recruited from community health centers that serve 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 black women and men, even after adjusting for other cardiovascular risk factors and the socioeconomic status. Overall, the risk of heart failure was about 19% higher among rural residents than among their urban counterparts. However, black men living in rural areas had the highest risk of all – a 34% higher risk of heart failure than black men living in urban areas.
The study showed that white women living in rural areas had a 22% increased risk of heart failure compared to white women in urban areas, and black women had an 18% higher risk than women black people in urban areas. No association was found between rural living and the risk of heart failure in white men.
The exact reasons for these rural-urban health disparities are unclear and are still being explored. The researchers said a host of factors could be at play, including structural racism, inequities in access to health care, and a shortage of grocery stores that provide healthy, affordable foods, among others.
“Finding an association between living in rural areas and an increased incidence of heart failure is an important breakthrough, particularly given its implications for helping address geographic, gender and racial disparities,” said David Goff, MD, Ph.D., Director, Division of Cardiovascular Sciences, NHLBI. “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 United States”
Heart failure is a chronic, progressive disease 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 when lying down. The condition, which has few treatment options, affects an estimated 6.2 million American adults.
Heart failure can be prevented by following a heart healthy lifestyle. NHLBI’s Roger, who is also a practicing cardiologist, noted that a major contributor to heart failure is hypertension, or high blood pressure, which black men experience at disproportionately high levels. The condition should be managed intensively by regularly checking blood pressure and taking prescribed medications. Other ways to reduce the risk of heart failure include avoiding all forms of tobacco, eating healthy, and exercising.
The 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 Intramural Research Division, the NHLBI Cardiovascular Research Training Award (T32 367 HL007411), the National Institute on Minority Health and Health Disparities Intramural Research Program, 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. For a full list of financial aid, please see the article published in the journal.