Racial disparities in death rates from chronic conditions magnified in rural areas

Have we made any progress in improving racial health inequities since the early 2000s? Researchers at Harvard Medical School, who published their findings in the Journal of the American College of Cardiology, wanted to find out.

A large body of evidence has shown that Black Americans experience worse cardiovascular outcomes than White Americans. The research team found that hypertension- and diabetes-related death rates are two to three times higher among Black adults than White adults in rural parts of the United States. They discovered that overall, Black adults have higher death rates from diabetes, hypertension, heart disease, and stroke than White adults and that these racial inequities are magnified in rural areas of the United States.

“What’s really concerning is our finding that these striking racial disparities have not meaningfully improved over the last 2 decades,” said lead study author Rishi K. Wadhera, MD.

Because rural communities face barriers in accessing health care services, the research team wanted to evaluate whether racial disparities have improved in these communities compared with urban areas.

According to Wadhera, racial disparities in death rates due to these conditions persist for several reasons.

“Black communities disproportionately face structural and systemic inequities, which lead to a higher burden of comorbid conditions and worse health outcomes,” she said.

Examples include poverty, living in disadvantaged areas that have pharmacy deserts and less access to healthy foods, as well as worse access to health care services such as primary and preventive care. Rural areas in particular have experienced a decline in primary care and specialist physicians along with an increase in rural hospital closures.

“These inequities may result in lower levels of awareness, treatment, and control for conditions like hypertension and diabetes,” said Wadhera.