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NIH Record - National Institutes of Health

Study Finds Higher Risk of Heart Failure in Rural Areas

A health professional checks a man's blood pressure

Study finds Black men living in rural areas have a higher risk of heart failure.


Adults living in rural areas of the U.S. have a 19% higher risk of developing heart failure compared to their urban counterparts, and Black men living in rural areas have an especially higher risk–34%, according to a large NIH-supported observational study. 

The study, largely funded by NHLBI, is one of the first to look at the link between living in rural America and first-time cases of heart failure. Findings from the study, produced in collaboration with Vanderbilt University Medical Center, were published in JAMA Cardiology.

“This study makes it clear that we need tools or interventions specifically designed to prevent heart failure in rural populations, particularly among Black men living in these areas,” said Dr. Véronique Roger, the study’s corresponding author and senior investigator, NHLBI Epidemiology and Community Health Branch.

Researchers from NHLBI and Vanderbilt analyzed data from the Southern Community Cohort Study, a long-term health study of adults in the southeastern U.S. They compared the rates of new onset heart failure among rural and urban residents in 12 states. 

The population, which included 27,115 adults without heart failure at enrollment, were followed for about 13 years. Nearly 20% of participants lived in rural areas; the remainder lived in urban areas. Almost 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 living in rural America 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 and Black women living in rural areas had an increased risk of heart failure compared to those in urban areas. No association was found between rural living and heart failure risk among white men.

The exact reasons for the disparities is unclear. 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.

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