Rurality and Heart Failure: The Southern Community Cohort Study

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Summary of findings Within the Southern Community cohort study population receiving services from Medicare or Medicaid, twenty percent of participants resided in rural areas. Over 13-years median follow-up, the age-adjusted HF incidence was 29.6/1,000 person years for urban and 36.5/1,000 person years for rural participants; p<0.001. After adjustment for demographics, CV risk factors, health behaviors, and SES, rural participants had a 19% greater risk of incident HF (HR 1.19, 95% CI 1.13-1.26) compared to their urban counterparts. The rurality associated risk of heart failure varied across race-sex groups and was greatest among Black men (Hazard ratio 1.34, 95% CI 1.19-1.51), followed by White women (Hazard ratio 1.21, 95% CI 1.06-1.38) and Black women (Hazard ratio 1.18, 95% CI 1.08-1.28). Among White men, rurality was not associated with greater risk of incident HF (Hazard ratio 0.97, 95% CI 0.81-1.15). We identified that among predominantly low-income individuals in the southeastern US, rurality was associated with an increased risk of HF among women and Black men, which persisted after adjustment for cardiovascular risk factors and socio-economic status. This inequity points to a need for additional emphasis on primary prevention of HF among rural populations. This data was presented as an oral abstract at the American Heart Association Epidemiology Meeting in March 2022 and published as an abstract: Turecamo S, Xu M, Joo J, Dixon D, Gupta DK, Lipworth L, Roger VL. Rurality and Incident Heart Failure Risk in The Southern Community Cohort Study. Circulation. 2022;145(Suppl_1).