Rural-urban disparities in cause-specific mortality in the USA have been reported for a variety of chronic conditions, including substance misuse, suicides, and organ system diseases. This has been on the backdrop of the well-documented phenomenon of rural areas characteristically experiencing worse health and higher mortality rates compared to urban areas. Studies have attributed this to regional socioeconomic deprivation, less access to healthcare, and reduced awareness in rural compared to urban areas. For cardiovascular disease, studies have noted the CVD-related mortality rates in the US declined in the first decade of the 21st century, followed by a plateau.

Over the past few years, the COVID-19 pandemic has disrupted provision of healthcare delivery both in urban and rural areas of the US, along with a demonstrable loss of life expectancy. The pandemic has brought about significant economic, social, and political challenges. However, there remains limited data around whether rural-urban disparities in cardiovascular-disease related mortality in the US have worsened particularly in the context of the COVID-19 pandemic. Furthermore, there is limited data on how temporal mortality trends in rural and urban areas vary when looking at specific CVD sub-types, and whether the COVID-19 pandemic has reversed the gains differentially amongst different CVD from the last two decades.

Our study aims to study the temporal evolution in cardiovascular disease-related mortality in rural and urban areas in the US from Jan 1st, 1999 to Dec 31st, 2020. We subsequently discuss CVD-related excess mortality in urban/rural areas in the context of the first year of the COVID-19 pandemic (2020) relative to the preceding twenty years (1999–2019).


Crown Copyright © 2023 Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Cite as

Chaganty, S., Abramov, D., Van Spall, H., Bullock-Palmer, R., Vassiliou, V., Myint, P., Bang, V., Kobo, O. & Mamas, M. 2023, 'Rural and urban disparities in cardiovascular disease-related mortality in the USA over 20 years; have the trends been reversed by COVID-19?', International Journal of Cardiology Cardiovascular Risk and Prevention, 19, article no: 200202. https://doi.org/10.1016/j.ijcrp.2023.200202

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Last updated: 05 September 2023
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