(HealthDay News) — Mortality rates of diabetes, hypertension, heart disease, and stroke are highest for Black adults living in rural areas, according to a research letter published in the Journal of the American College of Cardiology.

Rahul Aggarwal, MD, from Beth Israel Deaconess Medical Center in Boston, and colleagues used data from the U.S. Centers for Disease Control and Prevention Wonder Database for 1999 to 2018 to examine how mortality rates of diabetes, hypertension, heart disease, and stroke have changed for Black and White adults in rural versus urban areas.

The researchers found that annual age-adjusted mortality rates were substantially higher for Black versus White adults in rural areas for diabetes (average mortality rate 1999 to 2018, 76.2 vs 37.2 deaths per 100,000), hypertension (31.3 vs 10.9), heart disease (425.0 vs 331.7), and stroke (112.6 vs 73.9). Black adults also had higher average age-adjusted mortality rates for diabetes (63.0 vs 30.7), hypertension (25.3 vs 10.9), heart disease (371.0 vs 291.8), and stroke (89.4 vs 63.6) in urban areas. For diabetes and hypertension, the gap in annual age-adjusted mortality rates between Black and White adults narrowed more rapidly in urban versus rural areas from 1999 to 2018. In contrast, the racial gap in heart disease mortality declined at a similar rate in rural and urban areas and declined more rapidly for stroke in rural areas.

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“Targeted public health initiatives are urgently needed to reduce racial inequities in cardiovascular health in rural areas of the United States,” the authors write.

Two authors disclosed financial ties to the pharmaceutical and medical device industries.


Aggarwal R, Chiu N, Loccoh EC, et al. Rural-Urban Disparities: Diabetes, Hypertension, Heart Disease, and Stroke Mortality Among Black and White Adults, 1999-2018. J Am Coll Cardiol. 2021 Mar, 77 (11) 1480–1481