Association of Rurality With Risk of Heart Failure

Area of Science:

• Cardiovascular epidemiology
• Health disparities research
• Rural health

Background:

• Rural populations face higher heart failure (HF) mortality rates compared to urban populations.
• The incidence of HF in rural areas and its intersection with racial health inequities remain understudied.

Purpose of the Study:

• To investigate the association between rurality and the risk of incident heart failure (HF).
• To determine if this association is independent of cardiovascular disease risk factors and socioeconomic status.
• To examine how rurality-associated HF risk varies by race and sex.

Main Methods:

• Prospective cohort study of Black and White participants from the Southern Community Cohort Study (SCCS) without HF at enrollment.
• Rurality defined by Rural-Urban Commuting Area codes at the census-tract level.
• Cox proportional hazards regression models used to analyze the association between rurality and incident HF, with sequential adjustments.

Main Results:

• Rural participants had a 19% higher risk of incident HF compared to urban participants, persisting after adjustments.
• The risk varied by race and sex, with the highest risk observed in Black men, followed by White women and Black women.
• No increased HF risk was associated with rurality among White men.

Conclusions:

• Rurality is linked to increased HF risk, especially among women and Black men, even after accounting for cardiovascular risk factors and socioeconomic status.
• These findings underscore significant health inequities in rural populations.
• There is a critical need to enhance primary prevention strategies for HF in rural communities.