CVD mortality rates highlight ‘widening disparity’ between metro, rural counties in US

Cardiovascular disease (CVD) age-adjusted mortality rates (AAMRs) were higher in rural areas than larger metropolitan areas from 1999 to 2017, according to new research published in JAMA.

The study’s authors explored CDC data for their research, defining “rural” as counties with a population smaller than than 50,000. A “large metropolitan” county is one with a popular of more than one million. Counties with a population from 50,000-999,9999 were defined as “medium or small metropolitan.”

Overall, more than 16.1 million deaths in the United States were attributed to CVD from 1999 to 2017. While 49.6% of those deaths occurred in large metropolitan areas, 30.7% occurred in medium or small metropolitan areas and 19.7% occurred in rural areas.

The total AAMR did decline from 350.8 deaths per 100,000 people in 1999 to 219.4 in 2017. Rural areas had “consistently higher” AAMRs than metropolitan areas, the authors found; AAMRs were also higher among black and male populations.

The team also found that AAMRs declined in most subgroups—but there were a few exceptions when it came to individuals between the ages of 25 and 64. Their AAMR increased by 0.8% in medium and small metropolitan areas, and by 1.3% in rural areas.

Another key finding was that AAMRs have declined slower in rural areas, “resulting in a widening disparity between regions.”

“The increase in cardiovascular disease AAMRs among middle-aged individuals in medium and small metropolitan and in rural areas beginning in 2011, in addition to drug overdoses and suicide, may be contributing to reductions in life expectancy,” wrote lead author Sarah H. Cross, MSW, MPH, Sanford School of Public Policy at Duke University, and colleagues. “This disparity is likely driven by a combination of demographic changes, the economic slowdown, the high prevalence of CVD risk factors and poorer access to health care."