New findings from Vanderbilt University highlight a notable disparity in heart failure risk between adults living in rural regions and those in urban areas across the United States. The study reports that rural residents faced a roughly 19 percent higher likelihood of developing heart failure compared with their urban counterparts, a difference observed within a broad, representative sample and published in JAMA Cardiology. The observation underscores a persistent urban–rural gap in cardiovascular health that spans years of epidemiological data and regional life circumstances.
The researchers drew on data from a long-running health study focused on adults in the southeastern part of the country. They tracked the onset of heart failure among individuals living in both rural and urban settings across 12 states, beginning with a cohort of approximately 27,000 adults who did not have heart failure at the study’s start. Over an average follow-up period of about 13 years, the team monitored health outcomes, lifestyle factors, and medical histories to determine how residency patterns might influence cardiovascular risk over time.
Across the full cohort, rural residence was associated with higher heart failure risk compared with urban dwelling. The study also delved into subgroup analyses, revealing that the elevated risk persisted across racial subgroups but manifested with varying magnitudes. For instance, rural black men showed a 34 percent higher risk than their urban black counterparts. Among black women, the rural setting was linked to an 18 percent increase in risk, while white women experienced a 22 percent higher risk when living in rural areas. These findings point to an uneven distribution of cardiovascular risk that intersects with race and geography, suggesting that multiple, intersecting factors contribute to the observed differences.
While the precise causes behind these geographic and racial disparities remain under investigation, the researchers point to a range of possible contributing elements. Structural racism, unequal access to healthcare services, and limited availability of affordable, healthy food options in rural communities are among the factors being explored. Additional considerations include differences in economic stability, transportation access, environmental exposures, prevalence of risk factors such as hypertension and diabetes, and variations in healthcare delivery that can affect early diagnosis and ongoing management. The study emphasizes that addressing heart failure risk requires a comprehensive public health approach that considers how place, race, and socioeconomic status shape health outcomes. In the broader context of the United States, these insights support ongoing conversations about targeted prevention efforts in rural regions and the need for equitable healthcare infrastructure to improve cardiovascular outcomes across all communities.