Racial Disparities in Mortality Rates for Heart Disease, Hypertension, and Diabetes Have Seen Little Improvement in Two Decades


Black adults living in rural areas of the United States have experienced higher mortality rates due to diabetes, hypertension, heart disease, and stroke compared to white adults over the past 20 years, according to a research letter published in the Journal of the American College of Cardiology. Further, racial disparities have improved minimally in rural areas over the period of the study, whereas urban areas have seen larger improvements.

Mortality rates from each condition studied have been highest among Black adults living in rural areas over the past 2 decades. Diabetes and hypertension-related mortality are 2 to 3 times higher for Black adults compared to white adults, and mortality rates for all conditions across rural and urban areas were higher for Black adults compared to white adults, according to the study.

Between 1999 and 2018, the gap in mortality rates for diabetes and hypertension between Black and white adults narrowed more rapidly in urban areas than in rural areas. Similarly, racial disparities narrowed for heart disease and stroke mortality for rural Black adults.

"While modest gains have been made in reducing racial health inequities in urban areas, large gaps in death rates between Black and white adults persist in rural areas, particularly for diabetes and hypertension. We haven't meaningfully narrowed the racial gap in outcomes for these conditions in rural areas over the last 2 decades," said Rishi Wadhera, MD, MPP, MPhil, cardiologist at Beth Israel Deaconess Medical Center in Boston and senior author of the study, in a press release. "Given that diabetes, hypertension, and heart disease are preventable and treatable, targeted public health and policy efforts are needed to address structural inequities that contribute to racial disparities in rural health."

Researchers used data from the CDC Wonder Database to assess age-adjusted mortality rates for Black and white adults 25 years of age and older, stratified by rural or urban area from 1999 to 2018. They concluded that the racial disparities for diabetes and hypertension-related mortality in rural areas may be caused by structural inequities in terms of access to primary, preventive, and specialist care for rural Black adults.

Conversely, the improvements for heart disease and stroke mortality might reflect improvements in emergency services, the expansion of referral networks, the development of stroke and myocardial infarction care centers, and the implementation of time to procedure metrics, such as door-to-balloon.


Racial disparities in heart disease, hypertension, and diabetes death rates have minimally improved over last two decades [news release]. EurekAlert; March 15, 2021. Accessed March 17, 2021. https://www.eurekalert.org/pub_releases/2021-03/acoc-rdi031121.php

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