The Risk of Heart Failure is Higher in Rural Communities

Janet Tiberian Author
By Janet Tiberian, MA, MPH, CHES
May 15, 2023
The Risk of Heart Failure is Higher in Rural Communities

Many people find living in rural areas desirable. When compared to urban, even suburban living, a rural lifestyle usually includes a bigger home, a greater connection to nature and brighter nighttime skies. Rural residents also benefit from the peace and tranquility they experience in their communities. 

However, a major downside to rurality is poor health. Rural residents tend to be less healthy than their urban neighbors. Chronic conditions, particularly heart disease, are more common. In fact, there’s an association between rurality and heart failure, according to a study published in JAMA Cardiology.

Heart failure occurs when the heart can no longer pump enough blood to support the needs of the body. The condition is progressive and can lead to a buildup of fluid, causing shortness of breath and other breathing difficulties. 

Researchers from the National Heart, Lung and Blood Institute of the National Institutes of Health (NIH) and Vanderbilt University Medical Center collaborated to analyze data from The Southern Community Cohort Study. They compared rates of new heart failure cases among residents in 12 southern states – Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Virginia and West Virginia. About 20 percent of participants lived in rural areas, with the remainder living in urban areas. Almost 69 percent of participants were Black and recruited from community health centers that care for medically underserved people. And more than 27,000 participants did not have heart failure at the onset of the study. Participants were followed for 13 years. At the end of the study, researchers adjusted data for heart disease risk factors and socioeconomic status and found:

  • Participants in rural areas had a higher overall risk for heart failure compared to participants in urban areas, especially among women and Black men.
  • White women in rural areas had a 22 percent increased risk of heart failure compared to white women in urban areas.
  • Black women in rural areas had an 18 percent higher risk compared to Black women in urban areas. 
  • Black men in rural areas had a 34 percent higher risk for heart failure compared to Black men in urban areas.
  • No association between white men and heart failure was found whether living in a rural area or urban area.

“Researchers don’t fully understand why heart failure is higher in rural communities,” says Bernard Kaminetsky, MD, medical director, MDVIP. “However, rural areas also have higher rates of coronary artery disease -- the condition which leads to heart failure.”

Coronary artery disease is the leading cause of death in the U.S.; it’s caused by plaque accumulating along the inner walls of the arteries that supply blood to the heart. The disease is largely preventable by living a heart healthy lifestyle. Studies have found that rural areas have higher rates of coronary artery disease risk factors such as:

  • Obesity
  • Smoking
  • Poor dietary habits
  • Sedentary lifestyle
  • Type 2 diabetes
  • High blood pressure

“Some of the lifestyle issues have ties to a rural environment,” says Kaminetsky. “In other words, many rural communities lack sophisticated healthcare facilities, healthy food choices and wellness services. This is why I’m so proud that we have MDVIP-affiliated physicians in many rural areas throughout the country. It gives rural residents the same opportunities to focus on health and wellness that urbanites in MDVIP-affiliated practices have.” 

Looking for a primary care physician? Physicians in MDVIP-affiliated practices can customize a wellness plan for you that includes preventing and controlling heart disease. Find an MDVIP affiliate near you and begin your partnership in health »

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About the Author
Janet Tiberian Author
Janet Tiberian, MA, MPH, CHES

Janet Tiberian is MDVIP's health educator. She has more than 25 years experience in chronic disease prevention and therapeutic exercise.

View All Posts By Janet Tiberian, MA, MPH, CHES
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