Key result
High county-level deprivation linked to ~164% higher premature CVD mortality alongside severe care deficits.
Why the study?
Premature cardiovascular disease mortality in the United States is geographically uneven, and it is unclear whether high-burden communities face limited cardiovascular care infrastructure.
Does high area-level deprivation correlate with increased premature CVD mortality and limited cardiovascular care infrastructure in U.S. counties?
Observational (n=2,331)
Does high area-level deprivation correlate with increased premature CVD mortality and limited cardiovascular care infrastructure in U.S. counties?
Absolute Event Rate: 202.2% vs 76.5%
High-deprivation U.S. counties with excess premature CVD mortality suffer from a severe lack of cardiovascular care infrastructure, highlighting a critical target for health equity interventions.
May warrant targeted infrastructure investments in deprived counties; leaves open whether such changes reduce premature CVD mortality.
BACKGROUND: Premature cardiovascular disease (CVD) mortality in the United States is geographically uneven, but prevention planning requires identifying whether high-burden communities face limited cardiovascular care infrastructure. METHODS: Beginning with an England-U.S. comparison, we identified a high-risk U.S. county tail, defined as counties in both the highest deprivation quintile and the top quartile of county-level mean premature CVD mortality. We characterized these counties by rurality, cardiometabolic risk factors, insurance, primary care capacity, cardiology workforce, and cardiac-service availability. RESULTS: High-risk-tail counties were predominantly rural, had higher risk-factor burden and uninsurance, and had lower primary care and cardiovascular physician density. Most lacked local patient-care cardiovascular physicians, adult cardiology services, diagnostic catheterization, interventional catheterization, and cardiac rehabilitation. CONCLUSIONS: High-deprivation U.S. counties with excess premature CVD mortality represent a structural cardiovascular care gap. Geographically targeted prevention, workforce planning, and cardiac rehabilitation access should prioritize areas where premature mortality, deprivation, rurality, and limited cardiovascular infrastructure overlap.
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Khan et al. (2026) conducted an observational in Premature cardiovascular disease mortality (n=2,331). High area-level deprivation vs. Low area-level deprivation was evaluated on Age-standardized premature CVD mortality before age 75 years. High area-level deprivation in U.S. counties was associated with substantially higher premature CVD mortality (202.2 vs 76.5 deaths per 100,000) and severe deficits in cardiovascular care infrastructure.
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