Research in Brief: COVID-19 Exacerbated an Already Widening Gap Between Rural and Urban Heart Health Over Last Decade

Cardiovascular Health in Rural Communities Disproportionately Affected

Existing disparities in socioeconomic factors resulted in a U.S. rural population that was more vulnerable to the direct and indirect cardiovascular effects of COVID-19, according to investigators at the Richard A. and Susan F. Smith Center for Outcomes Research at Beth Israel Deaconess Medical Center (BIDMC). In a study presented at the American Heart Association Scientific Sessions and published in the Journal of the American College of Cardiology, scientists demonstrated that a growing gap in health outcomes between rural and urban populations only widened more quickly following the pandemic.

“Urgent action is needed to address these worsening inequities in social, economic, and health system factors that disproportionately affect rural communities and their cardiovascular health,” said lead author Lucas X. Marinacci, MD, a clinical fellow in cardiology at BIDMC who presented the data.

 “Improving cardiovascular health in rural communities has to become a national priority in the U.S.,” said corresponding author Rishi K. Wadhera, MD, MPP, MPhil, Associate Director of the Smith Center at BIDMC and Associate Professor at Harvard Medical School.

Wadhera, Marinacci, and colleagues evaluated cardiovascular mortality in the United States from 2010 to 2022, focusing on the impact of the pandemic on existing rural-urban disparities in cardiovascular health. Prior to the pandemic, age-adjusted cardiovascular deaths rates were decreasing in urban areas of the United States. In contrast, cardiovascular death rates were increasing in rural areas, driven largely by an alarming rise among younger adults. 

The investigators found that following the onset of the pandemic, while there was an increase in the cardiovascular mortality rate in urban areas, there was a steeper increase in the cardiovascular mortality rate in rural areas, particularly among rural adults aged 25-64. By 2022, cardiovascular mortality rates were 1.5 times higher in rural compared to urban areas.

Other studies suggest that for many people, risk factors such as high blood pressure, high cholesterol, diabetes, and obesity worsened during the pandemic, and rural areas may have been more severely affected due to greater interruptions in access to health care. The pandemic-related surge in substance use, depression, and suicidality also disproportionately impacted rural populations; these “diseases of despair” confer an increased risk of cardiovascular events.

“Deteriorating socioeconomic conditions and health system challenges that were exacerbated by the pandemic may have made rural adults more vulnerable to poor cardiovascular outcomes,” said Wadhera. “There’s a cardiometabolic health crisis happening in rural America—especially among young adults – and it’s vital that we start tackling the underlying socioeconomic conditions that are driving this the persistent rise in cardiovascular mortality.”

Co-authors include Stephen Mein, MD, ZhaoNian Zheng, MS, of BIDMC. 

Dr. Wadhera received research support for this research from the National Heart, Lung, and Blood Institute (R01HL174549) at the National Institutes of Health (NIH) and the American Heart Association Established Investigator award. Dr. Marinacci received support from grant T32-HL160522 from the NIH.