Black Americans who live in rural areas are two to three times more likely to die from diabetes and high blood pressure compared with white rural folks, and this gap hasn't changed much over the last 20 years, new research shows.
The study spanned from 1999 through 2018, and will be published as a research letter in the March 23 issue of the Journal of the American College of Cardiology.
Experts not involved in the research worry that this racial divide may have increased due to restrictions that COVID-19 has placed on daily life.
"The new findings are likely related to lack of access to primary and specialty care and even hospitals in rural areas," said Dr. Sadiya Khan, an assistant professor of cardiology and preventive medicine at Northwestern University's Feinberg School of Medicine in Chicago. "Widespread lockdowns during COVID-19 likely further impeded access to care and may have also increased behaviors known to raise risk of heart disease, including eating an unhealthy diet, not exercising and consuming more alcohol."
For the study, researchers analyzed racial breakdowns on death rates for Americans age 25 and older from the U.S. Centers for Disease Control and Prevention. They wanted to learn if racial differences in death rates for diabetes, high blood pressure, heart disease and stroke had changed in rural and urban areas.
And by and large, they didn't change much in rural areas from 1999 to 2018. They have been consistently highest among Black adults in those areas, the study said.
Overall, Black adults fared worse than white adults, but death rates due to heart-related conditions improved in urban areas, the study found.
And Black adults in rural areas had a greater risk of death from diabetes and high blood pressure, while the racial gap narrowed more rapidly in urban areas.
Study author Dr. Rahul Aggarwal, of Beth Israel Deaconess Medical Center and Harvard Medical School in Boston, cited several reasons for the "striking" divide.
"Black communities face system inequities which lead to worse health outcomes, including a higher burden of poverty, residence in disadvantaged areas, worse access to health care services such as primary and preventative care, and structural racism," Aggarwal said. "These issues are magnified in rural areas of the U.S."
Structural racism refers to policies and practices that can make it harder for Black Americans to advance.
Senior author Dr. Rishi Wadhera, a cardiologist at Beth Israel Deaconess Medical Center, said public health and policy initiatives are needed to tackle these issues, "which are inextricably tied to health and are driving racial health inequities."
Khan agreed. "We need housing stability for people in these areas who are homeless or struggle to find stable housing, along with Medicaid expansion so that a younger individual has access to care before Medicare eligibility," she said.
She also noted Black people in rural areas often lack access to computers and/or the internet. Online visits were among the main ways people saw their doctors during the earlier months of the pandemic. Lack of access to technology likely increased disparities in care and death rates from heart-related conditions, Khan said.
Dr. Keith Ferdinand, chairman of preventative cardiology at Tulane University School of Medicine in New Orleans, also reviewed the findings.
He said that a big part of the problem is that Black people in rural areas may not have adequate health insurance -- or any at all.
"With modern medicine, you can control blood sugar, cholesterol and hypertension and can decrease deaths from heart attacks and stroke, but the benefit is lost when people don't have adequate insurance and can't access care," Ferdinand said.
He said some of the trends can be reversed with grass roots education in these communities that focuses on leading a healthier lifestyle and understanding risks for heart disease.
Learn more about the risk factors for heart disease, diabetes and stroke that you can control at the American College of Cardiology.
SOURCES: Sadiya Khan, MD, MSc, assistant professor, cardiology and preventive medicine, Northwestern University Feinberg School of Medicine, Chicago; Rishi Wadhera, MD, MPP, MPhil, cardiologist and assistant professor, medicine, Beth Israel Deaconess Medical Center, Boston; Rahu Aggarwal, MD, clinical fellow, medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston; Keith Ferdinand, MD, chairman, preventive cardiology, Tulane University School of Medicine, New Orleans; Journal of the American College of Cardiology, March 23, 2021