Black people in rural areas are two to three times more likely to die from causes related to diabetes and high blood pressure than rural whites. That gap has persisted despite improvements for Blacks in urban settings, according to a recent study.
"What's really concerning is these disparities haven't meaningfully improved over the last two decades," said the lead author of the study, Dr. Rahul Aggarwal of Beth Israel Deaconess Medical Center and Harvard Medical School in Boston.
Scientists have known for years that rural Americans were more likely to die from cardiovascular disease than their city counterparts. But researchers wanted to see if recent efforts to reduce the racial gap in health were working comparably.
First, they looked at U.S. deaths for Black and white adults ages 25 and older from 1999 to 2018. Then they zeroed in on where people lived and what cardiovascular conditions were listed as a cause of death.
While the study found death rates in rural areas were higher for Black adults compared with white adults for heart disease and stroke, it did show the racial gap in heart disease deaths declined at a similar rate in both rural and urban areas – and fell more rapidly for stroke in rural areas than in urban ones.
But the gap was especially wide for deaths related to diabetes and high blood pressure – two to three times higher for Black rural residents than white.
A different picture emerged in urban areas. The gap between the rate of deaths for diabetes and high blood pressure among Black and white people improved about three times faster in cities and nearby suburbs than it did in rural areas.
The findings suggest a dire need for health care improvements in rural areas, where about 60 million Americans, or 20% of the population, live.
"It's important to modify public health and policy initiatives so we can get to the root causes of these regional inequities, including income inequality, structural racism and access to health care services," Aggarwal said.
The American Heart Association has advocated better long-term funding for Medicaid patients and for rural hospitals and care clinics and has emphasized digital tools and telemedicine to improve cardiovascular health in rural areas.
"From a rural perspective, you have to think of new solutions," said Dr. Keith Churchwell, executive vice president and chief operating officer at Yale New Haven Hospital in Connecticut. "This may be an opportunity to take a deeper dive to see if telehealth can lead to better pathways to improve care."