Rural/Urban Disparities in Cardiovascular Disease in the US—What Can be Done to Improve Outcomes for Rural Americans?

For the last forty years in the United States, there has been a progressively widening disparity in cardiovascular disease (CVD) morbidity and mortality between rural and urban areas known as the “rural mortality penalty.” Drivers of rural-urban disparities in CVD are multifactorial, including differences in demographics, education, economic opportunity, access to care, and healthcare quality. Because of the complex and heterogenous nature of rural areas in the United States, definitions of rural vary significantly, leading to challenges in quantifying disparities and targeting interventions. Potential solutions to increase access to cardiovascular care in rural areas include initiatives to expand the primary care and cardiology workforces, build partnerships between rural healthcare providers and academic medical centers (AMC), establish more outreach clinics in underserved or poorly resourced rural communities, develop rural provider training programs, expand and improve telemedicine offerings, develop community wide CVD prevention programs, expand health insurance coverage in rural areas, continue government support of rural hospitals and address social determinants of health as rural populations often face higher rates of poverty, food insecurity, unemployment, housing instability, and limited access to education, all of which exacerbate health disparities.