(HealthDay News) — Residents in rural counties have higher age-adjusted mortality rates (AAMRs) for heart failure-related death compared with urban adults, according to a study published online in PLOS ONE.

Jacob B. Pierce, from the Northwestern University Feinberg School of Medicine in Chicago, and colleagues calculated national AAMRs for heart failure-related deaths and examined trends stratified by rural-urban status, age, and race-sex subgroups per year. The incidence rate ratios were estimated in heart failure-related mortality for rural versus urban counties.

The researchers identified 162,314 and 580,305 heart failure-related deaths in rural and urban counties, respectively, between 2011 and 2018. Compared with residents in urban counties, those in rural counties consistently had higher AAMRs (73.2 vs 57.2 in 2018). Rural Black men had the highest AAMR (131.1 in 2018), and the greatest increases in heart failure-related mortality were seen for those aged 35 to 64 years (+6.1% per year). After adjustment for county-level factors, the rural-urban incidence rate ratio persisted among younger and older adults (1.10 and 1.04, respectively).

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“Our study decomposing the rural-urban disparity in heart failure-related mortality identifies complex and multilevel factors and suggests that extensive clinical and public health interventions targeting health and economic policy, socioeconomic disparities, access to care, and clinical and behavioral risk factors will be required to reduce this disparity,” the authors write.


Pierce JB, Shah NS, Petito LC, et al. Trends in heart failure-related cardiovascular mortality in rural versus urban United States counties, 2011–2018: A cross-sectional study. PLOS One.