May 12 (UPI) -- The gap in heart disease death rates between urban and rural areas of the United States has doubled in the last two decades, despite continued improvement across the country to survival rates, a new analysis shows.
Research published Tuesday in JAMA reveals that just under half of the more than 16.1 million deaths linked to cardiovascular conditions from 1999 to 2017 occurred in large metropolitan areas, but residents of rural areas also saw declines in life expectancy and slower reductions to heart-linked mortality rates over that period.
"We have known that rural areas have higher mortality than urban areas," Dr. Haider J. Warraich, associate director for the heart failure program at the VA Boston Healthcare System, told UPI.
"This study not only confirms that finding, but shows that the difference is actually increasing over time rather than getting better," he said.
Nearly half of all Americans have some form of heart disease, according to the U.S. Centers for Disease Control and Prevention, and roughly 650,000 die annually as a result of related causes.
For the analysis, Warraich and his colleagues reviewed findings from the CDC's Wide-ranging Online Data for Epidemiologic Research, or WONDER, database, focusing on deaths from cardiovascular disease between 1999 and 2017.
They calculated age-adjusted mortality rates, or AAMRs, for metropolitan, suburban and rural areas by multiplying the age-specific death rate for each age group by the corresponding per capita ratio for each region type based on the 2000 U.S. census population, and then multiplying by 100,000.
The researchers found that between 1999 and 2017, roughly 16.1 million deaths were caused by cardiovascular disease in the United States. Of these, 49.6 percent occurred in large metropolitan areas, 30.7 percent in medium and small metropolitan areas, and 19.7 percent in rural areas.
However, over the same period, the researchers determined that AAMRs declined 4.1 percent in large metro areas and 3.7 percent in smaller metro areas, while declining just 3.2 percent in rural regions.
As a result, the difference between AAMRs in rural areas and large metropolitan areas nearly doubled between from 1999 and 2017, increasing from 24 deaths per 100,000 population in 1999 to 42.8 deaths per 100,000 population in 2017.
"This should be a wake-up call for the American people and policymakers: rural health has been ignored far too long and the rural health system has not been designed to help patients with chronic conditions like cardiovascular diseases," Warraich said.
"The rural health system is in dire need of transformation," he said. "What we need is a more robust outpatient and population-focused healthcare system that incentivizes improvement in outcomes rather than rewards hospitalizations and procedures."