January 25, 2023

Study finds heart failure risk higher in rural areas

A study co-led by Vanderbilt researchers found heart failure risk is 19% higher for adults living in rural areas of the U.S., as compared to urban areas, and 34% higher for Black men living in rural areas.

Heart failure risk is 19% higher for adults living in rural areas of the U.S., as compared to urban areas, and 34% higher for Black men living in rural areas, according to a large, observational study supported by the National Institutes of Health (NIH) and co-led by Vanderbilt University Medical Center researchers.

The study, one of the first to look at the link between first-time cases of heart failure and patients living in rural areas, was published in JAMA Cardiology.

“The study demonstrates the relationship between rurality and the occurrence of heart failure and is the first to do so in a predominantly low-income population of Black and white adults residing in the southeastern U.S.,” said Loren Lipworth, ScD, professor of Medicine and associate director of the Division of Epidemiology, who co-led the study for VUMC along with Deepak Gupta, MD, associate professor of Medicine and director of the Vanderbilt Translational and Clinical Cardiovascular Research Center, Division of Cardiovascular Medicine.

Researchers from the National Heart, Lung, and Blood Institute (NHLBI) — which is part of the NIH — and VUMC analyzed data from The Southern Community Cohort Study, comparing rates of new onset heart failure among rural and urban residents in 12 states (Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Virginia and West Virginia).

The population, which included 27,115 adults without heart failure at enrollment, was followed for about 13 years. Nearly 20% of participants lived in rural areas and roughly 69% were Black adults recruited from community health centers that care for medically underserved populations.

At the end of the study period, the researchers found that rurality was associated with an increased risk of heart failure among both women and Black men, even after adjustment for other cardiovascular risk factors and socioeconomic status.

The study showed white women living in rural areas had a 22% increased risk of heart failure compared to white women in urban areas, and Black women had an 18% higher risk compared to Black women in urban areas.

No association was found between rurality and heart failure risk among white men.

“Our findings in the Southern Community Cohort Study highlight race- and sex-based inequities in heart failure risk that have important implications for the primary prevention of heart failure, including a need to focus on community or contextual factors that may preferentially impact women or Black men living in rural areas,” Lipworth said.

Heart failure, which affects an estimated 6.5 million adults in the U.S., develops when the heart does not pump enough blood for the body’s needs or requires higher pressure to do so. Its symptoms may include shortness of breath during daily activities or trouble breathing when lying down, among others. Patients with heart failure often have lower quality of life and shorter survival, which raises the importance of preventing heart failure.

“Approximately 1 million new cases of heart failure are diagnosed in the U.S. each year,” Gupta said. “Our findings demonstrate substantial variability in susceptibility to heart failure. The results not only emphasize the importance of identifying these differences, but also suggest heart failure prevention may require varied approaches across individuals.

“As Vanderbilt is a leader in precision medicine, our next step should be to translate these observational findings into targeted interventions to prevent heart failure, particularly among individuals who bear a disproportionate burden of risk,” he added.

The exact reasons behind these rural-urban health disparities are unclear and are still being explored. But the researchers said a multitude of factors may be at play, including structural racism, inequities in access to health care, and a dearth of grocery stores that provide affordable and healthy foods, among others.

The study was funded by the NIH Medical Research Scholars Program; NHLBI’s Division of Intramural Research; the NHLBI Training Award in Cardiovascular Research (T32 367 HL007411); the Intramural Research Program of the National Institute on Minority Health and Health Disparities; the National Cancer Institute (grants R01 CA092447 and 368 U01 CA202979); and supplemental funding from the American Recovery and Reinvestment Act (3R01 CA 029447-0851).

Other VUMC co-authors include Meng Xu, Debra Dixon, and Michael Mumma.