More than a fifth of Americans living in rural areas live three years less than those in the cities—mostly due to heart diseases and strokes, according to a new study. This disparity largely widened between 2010 and 2022, driven by a 21 per cent increase in cardiovascular deaths among working-age rural adults, the research published in the Journal of the American College of Cardiology noted.

Doctors say this is the first national analysis of rural cardiovascular health during COVID-19, even as heart disease and stroke deaths shot up with the arrival of the pandemic in 2020, which had been decreasing in both rural and urban communities.

“It is inexcusable for young adults to be experiencing an increase in cardiovascular death rates anywhere in this country,” said Dr. Rishi Wadhera, a cardiologist at Beth Israel Deaconess Medical Center in Boston and the senior author of this study.

According to experts, the findings are not surprising, as cardiovascular mortality has always been worse in rural areas due to a collision of factors, which include:

• Drug use
• Poor health
• Smoking and alcohol
• Limited access to care

However, the study raises questions about what is driving these widening disparities and what, if anything, can stem the bleeding.

For the study, the researchers team examined death certificate data by age for over 11 million adults. Between 2010 and 2022, cardiovascular deaths increased among 25- to 64-year-olds but decreased among people ages 65 and up.

In rural communities, those increases occurred at a faster rate, and the decreases occurred at a slower rate than in their urban counterparts. Doctors say there are various underlying risk factors, which include hypertension or high blood pressure, diabetes, and obesity—rising steeply among younger adults over the past decade, with rural areas disproportionately affected.

It is also tied to systemic issues like lower health education, higher unemployment and not having easy access to gyms and fresh food.

Experts say small towns and rural areas in the US have also been affected deeply by the opioid crisis—worsening people’s economic conditions as well as leading to heart issues and deaths. Overdoses from stimulants like methamphetamine and cocaine have also been on the rise.

According to the study, COVID-19 magnified other issues as well, increasing cardiovascular mortality by 3.6 per cent in urban areas but by 8.3 per cent in rural areas between 2019 and 2022. “The pandemic is an external stressor that just made all of those underlying social determinants worse,” Dr. Wadhera said.

Dr. Wadhera said most overdose deaths happened during the pandemic as treatment resources were disrupted and people turned to drugs as coping mechanisms. With hospitals stressed by COVID-19 patients and, in rural areas, shutting down at record rates, preventive heart screenings also declined, along with hospitalization rates.

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