Introduction
Heart disease is the leading cause of death in the United States. The term “heart disease” encompasses several conditions, including coronary artery disease, heart attacks, and heart failure. There are numerous factors that can impact your risk of heart disease, including age, gender, race and socioeconomic status.
Heart Disease in Rural Areas
One major risk factor associated with heart disease is living in rural areas. The risk of developing heart failure is 19% higher in adults living in rural areas compared to those in urban areas, according to a study published in JAMA Cardiology. This disparity is even more apparent among Black men, who have a 34% higher risk of heart failure. Black adults in rural areas reported having worse overall health, higher rates of chronic conditions and more obesity, indicating serious issues with their overall health.
Barriers
According to a study published in Circulation, rural Americans face a number of barriers when it comes to their cardiovascular health. Rural populations tend to be older, with 19% of the population being over the age of 65, making heart disease more likely. Obesity is more prevalent and 62.8% of rural residents report being physically inactive. People in rural areas also report poorer mental health status which can be a risk factor for heart disease. Depression and suicide rates are higher, but there is limited access to mental health professionals. Less than 10% of mental health professionals work in rural areas, despite 20% of the population living there.
The social determinants of health play a major role in heart disease outcomes as well. Rural populations tend to have lower income and education levels. Further, high risk occupations such as mining are more common in rural areas. Transportation is also a significant issue, as 3.6 million Americans are unable to receive care due to transportation issues each year. Rural Americans often have to travel much farther to reach a hospital and are less likely to have access to public transportation.
Even when people are able to reach hospitals, the quality of care they receive may not be the same. 40% of hospitals in the United States are in rural regions, but they have only 20% of the hospital beds. Rural hospitals are typically smaller and are not able to treat as many patients at once. They also face challenges with funding, especially in states with less Medicaid coverage. As a result, over 100 rural hospitals have closed since 2010, further widening the disparities in access to care.
Next Steps
Addressing these inequities in heart disease rates requires a multifaceted approach. Expanding upon existing solutions, improving infrastructure, and tackling the root causes of health disparities is essential to improving the health of rural Americans. There are several interventions that currently have the potential to help mitigate these disparities.
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Prevention
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- Preventing the onset of heart conditions is the best way to reduce the burden of disease. Personalizing preventive interventions can be a valuable tool for reducing disparities. Strategies that work in urban areas may not be as effective in rural areas, which is why tailoring preventive efforts based on an individual or population’s lifestyle and context is so important.
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Telemedicine
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- A study in Preventive Medicine highlighted the potential of telemedicine to improve care for heart conditions. Specifically, they discussed cardiac rehabilitation (CR), an intervention recommended after a patient undergoes hospitalization for conditions such as myocardial infarction, coronary revascularization, and more. CR involves exercise, lifestyle education, and emotional support. CR is known to reduce mortality and morbidity, but often goes underutilized. A major reason for this is patients must travel to a facility to use CR, and this can be a major challenge for those living in remote, rural areas. Telemedicine offers the ability to provide the same services as traditional CR programs, without the barrier of patients needing to be in-person. Recent findings suggest that telemedicine could reduce the gap in CR usage and can improve the likelihood that patients follow through on the program.
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Education
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- A lack of healthcare literacy is one factor that contributes to the high rates of heart disease in rural populations. Male farmers tend to disregard their risk and the serious implications of heart disease. Community based interventions can help educate adults in rural areas about their risk, increase awareness, and alter their prescription to recognize the severity. Interventions like the Rural Cardiovascular Health Initiative in New Mexico increase awareness, engagement, and education. They work with local hospitals and members of the community to ensure that interventions are targeted and effective for the population they are trying to reach.
Conclusion
The disproportionately high rates of heart disease among those living in rural areas is a serious concern. Compounded by other factors such as age, race, and socioeconomic status, adults in rural regions may face a much higher risk than their urban counterparts. Heart disease kills hundreds of thousands of people each year in the United States alone, so addressing this disparity is imperative. Preventive interventions, telemedicine, and increased education have the potential to greatly reduce heart disease mortality and improve the health of rural Americans.