For the past 20 years, black adults who lived in rural areas of the United States had high death rates from diabetes, high blood pressure, heart disease, and stroke compared to white adults. According to a research letter published in the Journal of the American College of Cardiology, racial disparities in rural areas have improved only minimally over the past two decades, with greater improvements occurring in urban areas.
“While modest progress has been made in reducing racial health inequalities in urban areas, large differences in death rates between black and white adults remain in rural areas, particularly for diabetes and high blood pressure. We have the racial differences in results for these areas are not significantly reduced. ” Conditions in rural areas for the past two decades, “said Dr. Rishi Wadhera, MPP, MPhil, cardiologist at Beth Israel Deaconess Medical Center in Boston and lead author of the study.” Given that diabetes, high blood pressure and heart disease are preventable and treatable targeted public health and policy efforts are needed to address structural inequalities that contribute to racial inequalities in rural health. “
Using data from the CDC Wonder Database, researchers assessed age-adjusted death rates for black and white adults aged 25 and over stratified by rural or urban areas from 1999 to 2018. They then determined whether the death rates were different between black and white.The condition – diabetes, high blood pressure, heart disease, and stroke – has changed over time in rural areas compared to urban areas.
For the past two decades, the death rate for any disease has been highest in rural black adults – diabetes and hypertension-related mortality are two to three times higher in black adults than in white adults. Throughout the study period, the researchers found that rural and urban death rates were higher among black adults than white adults in all conditions. However, between 1999 and 2018, the gap in death rates between black and white adults narrowed faster in urban areas from diabetes and high blood pressure than in rural areas. In contrast, racial disparities in heart disease and stroke mortality decreased in rural black adults.
According to the researchers, persistent racial disparities in diabetes and mortality from high blood pressure in rural areas may reflect structural inequalities that hinder access to primary, preventive and specialized care for rural black adults. However, the modest improvement in racial disparities in heart disease and stroke mortality in rural areas can be attributed to improvements in emergency services, expanding referral networks, developing stroke and myocardial infarction centers, and implementing time-to-procedure metrics such as door to the balloon .
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The following JACC link to the article can be published in news articles and will go live after the embargo: https://www.jacc.org/doi/10.1016/j.jacc.2021.01.032
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