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Rural Americans, especially Black men, have greater risk of heart failure


The disparity surprised even the authors of the NIH-supported study. The researchers suggested a lack of access to healthcare and structural racism are likely contributors.

Americans living in rural areas have a significantly higher risk of developing heart failure than those living in cities, according to a large study supported by the National Institutes of Health.

Black men living in rural areas face an especially high risk of heart failure, the study found.

The National Heart, Lung, and Blood Institute, a division within the NIH, collaborated with Vanderbilt University Medical Center on the study. The findings were published Jan. 25 in JAMA Cardiology.

Rural Americans had a 19% higher risk of heart failure than those living in urban areas, the study found. However, Black men living in rural communities had a 34% higher risk of heart failure than Black men living in urban areas, the highest risk of all those studied, researchers said.

Women in rural areas also faced greater likelihood of developing heart failure, according to the study.

White women in rural areas had a 22% increased risk of heart failure, compared to white women in metropolitan areas. Black women had an 18% higher risk of heart failure than Black women in urban communities.

Even the researchers were surprised by the disparities, said Véronique L. Roger, a co-author of the study and a senior investigator within the National Heart, Lung, and Blood institute.

“We did not expect to find a difference of this magnitude in heart failure among rural communities compared to urban communities, especially among rural-dwelling Black men,” Roger said in a statement accompanying the study. “This study makes it clear that we need tools or interventions specifically designed to prevent heart failure in rural populations, particularly among Black men living in these areas.”

The authors said the precise reasons for the greater risk of heart failure in rural communities aren’t entirely understood.

However, researchers said a lack of access to healthcare, structural racism, and a paucity of grocery stores offering healthy foods are all likely contributing factors.

The study found that white men living in rural areas did not indicate a higher likelihood of heart failure than white men in urban areas.

Researchers tracked 27,115 people over a 13-year period. The study examined participants in 12 states: Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, and West Virginia.

The researchers examined data from the Southern Community Cohort Study, a long-running study of major diseases in the Southeast.

David Goff, director of NHLBI’s Division of Cardiovascular Sciences, said finding a link between living in rural areas and a greater chance of heart failure is “an important advance.”

“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 U.S.,” Goff said in a statement.

Other studies have shown disparities in care between Black and white Americans in treating heart failure. White patients are much more likely than Black patients to receive heart transplants and devices that help the heart function properly, researchers found in a study that was also supported by the NIH.

Black and Latinx patients also experienced greater delays in cancer care during the COVID-19 pandemic, according to a study published in July by Jama Network Open.

President Biden’s administration has focused on closing disparities in health outcomes among disadvantaged groups.

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