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More work is needed to close the racial gap in cardiovascular mortality in the rural U.S., one study showed.

From 1999 to 2018, annual age-adjusted rates of mortality from diabetes, hypertension, heart disease, and stroke were consistently higher for Black adults compared with white adults in urban and rural areas alike, with diabetes- and hypertension-related mortality about two to three times higher in rural settings, according to Rishi Wadhera, MD, MPP, MPhil, of Beth Israel Deaconess Medical Center in Boston, and colleagues, who used the CDC Wonder Database for their analysis.

"These marked racial disparities have improved minimally over the last 20 years, although more pronounced improvements have occurred in urban areas," they reported in the .

Urban areas saw a faster narrowing of the racial gap compared with rural areas when it came to diabetes mortality (change in Black vs white difference -0.94 vs -0.24 deaths per 100,000 per year, P<0.001 for interaction between rural area and time) and deaths from hypertension (-0.30 vs -0.09, P=0.03).

"The striking and persistent racial disparities for diabetes- and hypertension-related mortality in rural areas, relative to urban areas, may reflect structural inequities that impede access to primary, preventive, and specialist care for rural Black adults," according to the authors.

On the other hand, rural areas did better at reducing the racial disparity in stroke mortality (-1.35 vs -0.80, P=0.02),

Additionally, urban and rural settings shared a similar narrowing of the racial gap in heart disease deaths (-3.21 vs -3.65, P=0.46).

"These changes may reflect improvements in emergency services, the expansion of referral networks, the development of stroke and MI care centers, and the implementation of time-to-procedure metrics," Wadhera and colleagues suggested.

"Targeted public health initiatives are urgently needed to reduce racial inequities in cardiovascular health in rural areas of the United States," they concluded.

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