Social factors help explain the poorer cardiovascular health of adults living in rural areas compared to those living in urban areas.
March 31, 2025
Media Advisory
Monday, March 31, 2025
An NIH-funded study reveals variables, such as poverty and education, that may explain higher rates of heart disease and its risk factors.
What
A National Institutes of Health (NIH)-funded research team has discovered higher rates of heart disease and poorer heart health among adults living in rural communities compared to urban areas, as well as the factors that likely cause these differences. They found that adults living in rural areas were more likely than those living in large cities to have heart disease (7 % vs. 4 %), high blood pressure (37 % vs. 31 %), high cholesterol (29 % vs. 27 %), obesity (41 % vs. 30 %), and diabetes (11 % vs. 10 %). Across all age groups, differences in high blood pressure, obesity, and diabetes were greatest among adults aged 20 to 39 living in rural areas compared with cities.
Researchers examined data from more than 27,000 adults who participated in the 2022 National Health Interview Survey. to understand geographic differences in heart disease rates and risk factors for diseases affecting the heart and blood vessels, such as high blood pressure, diabetes, and obesity. Since higher rates of heart disease have been established among adults in rural areas compared to cities, they also sought to understand the factors behind these variations. They found that factors such as income and education levels, having sufficient food, and home ownership mainly explained the higher rates of high blood pressure, diabetes, and heart disease among people living in rural areas. Previous research
also showed how difficult circumstances, such as living in poverty, can affect cardiovascular health, particularly by increasing inflammation in the body. Furthermore, access to healthcare, which is important for overall health, did not play a role in these differences. Lifestyle risk factors for heart disease, such as smoking and lack of physical activity, also did not explain these differences, although adults living in rural areas were more likely to smoke and be less active. The researchers also found that rates of high blood pressure, high cholesterol, diabetes, and heart disease were higher in rural areas than in cities in the South. Obesity rates were higher in rural areas of the United States, particularly in the Northeast. More than 60 million American adults live in rural communities, and heart disease remains the nation's leading cause of death. In this study, 1 in 7 adults lived in rural areas (counties with fewer than 50,000 residents), 1 in 2 lived in small or mid-sized cities (counties with populations of 50,000 to fewer than 1 million), and 1 in 3 lived in large cities (counties with populations of 1 million or more).
Identifying the factors behind the higher burden of heart disease and risk factors in rural areas remains a key research priority. The authors emphasize that insights from their study could inform public health efforts and policies aimed at supporting and improving the cardiovascular health of people, particularly young adults, living in rural areas.
The study was funded by a grant from the National Heart, Lung, and Blood Institute (NHLBI)
R01HL174549
. WhoSean Coady, MA, Deputy Chief of the
branch of epidemiology
, Division of Cardiovascular Sciences, NHLBI StudyLiu M, Marinacci LX, Joynt Maddox KE, Wadhera, RK. Cardiovascular Health Among Rural and Urban US Adults—Healthcare, Lifestyle, and Social Factors.
JAMA Cardiol.
2025; doi: 10.1001/jamacardio.2025.0538 . About the National Institutes of Health (NIH):The NIH, the nation's medical research agency, comprises 27 institutes and centers and is a component of the U.S. Department of Health and Human Services. The NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research. It studies the causes, treatments, and cures for common and rare diseases. For more information about the NIH and its programs, visit
www.nih.gov . NIH…Transforming Discovery into Health®
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