THURSDAY, May 20, 2021 (American Heart Association News) – According to a new study, deaths from diabetes and high blood pressure among blacks has improved in urban areas over the past two decades, but rural communities are lagging behind.
Scientists have known for years that people in rural America are more likely to die of cardiovascular disease than their urban counterparts. However, the researchers wanted to find out if recent efforts to reduce racial disparities in health are working equally in both regions of the country.
First, they looked at deaths in the United States for black and white adults aged 25 and older from 1999 to 2018. Then they looked at where people lived and what cardiovascular diseases were listed as the cause of death.
While the study found that rural death rates were higher among black adults than white adults from heart disease and stroke, it showed that racial disparities in deaths from heart disease decreased similarly – and decreased faster – in both rural and urban areas for stroke in rural areas than in urban.
However, the gap was particularly wide for deaths from diabetes and high blood pressure. Black rural dwellers were two to three times more likely to die from these conditions than white rural dwellers.
The picture was somewhat different in urban areas. The gap between the death rate from diabetes and high blood pressure among blacks and whites improved about three times faster in cities and nearby suburbs than in rural areas.
“What is really worrying is that these differences have not improved much in the past two decades,” said lead author Dr. Rahul Aggarwal, a resident physician at Beth Israel Deaconess Medical Center and Harvard Medical School in Boston.
The results suggest that there is an urgent need to improve health care in rural areas, he said. “It is important to change public health initiatives and policies so that we can identify the root causes of these regional inequalities, including income inequality, structural racism and access to health services.”
The study will be presented on Friday at the American Heart Association’s virtual epidemiology, prevention, lifestyle and cardiometabolic health conference. The research was also published in the Journal of the American College of Cardiology.
Approximately 60 million Americans – 20% of the US population – live in rural areas. Last year, the American Heart Association published a rural health recommendation in Circulation magazine calling for better long-term funding for Medicaid patients and rural hospitals and nursing clinics. The opinion also recommended the use of digital and telemedicine tools to improve cardiovascular health in rural areas.
“From a rural perspective, you have to think about new solutions,” said Dr. Keith Churchwell, executive vice president and chief operating officer, Yale New Haven Hospital, Connecticut. “This could be an opportunity to take a deeper dive to see if telemedicine can lead to better ways to improve care.”
Rural doctors face unique challenges, including isolation and lack of healthcare professionals, said Churchwell, who was not involved in the new study. “Your ability to care for patients is at risk of being disrupted.”
He called for more research to find out why racial disparities are improving in urban areas due to diabetes and high blood pressure, and to see how those gains can be duplicated in rural areas. “There can be lessons we can learn about improving therapies, outcomes, and overall care for populations everywhere.”
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By Thor Christensen
