Rural-Urban Disparities

Rahul Aggarwal; Nicholas Chiu; Eméfah Loccoh; Dhruv S. Kazi; Robert W. Yeh; Rishi K. Wadhera

doi:10.1016/j.jacc.2021.01.032

March 1, 2021Journal of the American College of CardiologyOpen Access

Rural-Urban Disparities

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Key Points

To evaluate national changes in mortality rates from diabetes, hypertension, heart disease, and stroke among Black and White adults in rural versus urban areas from 1999 to 2018.
Extracted death certificate data from the CDC WONDER database (1999–2018) for Black and White adults aged 25 years or older.
Calculated annual age-adjusted mortality rates per 100,000 individuals stratified by rural or urban status, standardized to the 2000 U.S. census.
Evaluated differences in Black versus White mortality trends between rural and urban areas using weighted least squares models with a race-by-rurality-by-time interaction term.
Rural Black adults had the highest average age-adjusted mortality rates across all causes: diabetes (76.2 vs. 37.2 deaths per 100,000; p < 0.001), hypertension (31.3 vs. 10.9; p < 0.001), heart disease (425.0 vs. 331.7; p < 0.001), and stroke (112.6 vs. 73.9; p < 0.001) compared with rural White adults.
Racial mortality disparities narrowed more rapidly in urban than rural areas for diabetes (Black vs. White annual difference change: −0.94 vs. −0.24 deaths per 100,000; p < 0.001) and hypertension (−0.30 vs. −0.09; p = 0.03).
Racial gaps declined at similar rates in urban and rural areas for heart disease (−3.21 vs. −3.65; p = 0.46) but closed faster in rural areas for stroke (−0.80 vs. −1.35; p = 0.02).

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Implication

Observational study reveals persistent racial disparities in cardiovascular mortality in rural adults, highlighting uneven public health progress across geographic regions.

Abstract

Diabetes, Hypertension, Heart Disease, and Stroke Mortality Among Black and White Adults, 1999–2018

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Cite This Study

Aggarwal et al. (2021) studied this question.

synapsesocial.com/papers/6a58f66c191b4970bd6cfa1f https://doi.org/10.1016/j.jacc.2021.01.032

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Rural-Urban Disparities

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