Rural–urban disparities in cardiovascular disease mortality vary by poverty level and region

Abstract Purpose To examine rural and urban disparities in cardiovascular disease (CVD) death rates by poverty level and region. Methods Using 2021 county‐level population and mortality data for CVD deaths listed as the underlying cause among adults aged 35–64 years, we calculated age‐standardized CVD death rates and rate ratios (RR) for 4 categories of counties: high‐poverty rural, high‐poverty urban, low‐poverty rural, and low‐poverty urban (referent). Results are presented nationally and by US Census region. Findings Rural and urban disparities in CVD mortality varied markedly by poverty and region. Nationally, the CVD death rate was highest among high‐poverty rural areas (191 deaths per 100,000, RR: 1.76, CI: 1.73–1.78). By region, Southern high‐poverty rural areas had the highest CVD death rate (256 deaths per 100,000) and largest disparity relative to low‐poverty urban areas (RR: 2.05; CI: 2.01–2.09). In the Midwest and West, CVD death rates among high‐poverty areas were higher than low‐poverty areas, regardless of rural or urban classification. Conclusions Results reinforce the importance of prioritizing high‐poverty rural areas, especially in the South, in efforts to reduce CVD mortality. These efforts may need to consider socioeconomic conditions and region, in addition to rural and urban disparities.