Racial Disparities Remain for Diabetes and HTN Mortality in Rural Areas

A black woman with cancer is meeting with her doctor. The doctor is a mixed-race man of Asian and Indian descent. The two individuals are seated next to each other. The medical professional is using a stethoscope to check the patient’s heart and lungs. The patient is wearing a bandana to hide her hair loss from chemotherapy treatment.
Racial inequities in cardiovascular health care persist in rural areas of the United States.

With minimal improvement across the past 2 decades, racial disparities between Black and White patients continue to be widest with regards to mortality rates for diabetes and hypertension (HTN), with Black adults 2 to 3 times more likely to die from complications compared with their White counterparts. During the same time period, rural racial disparities have narrowed between Black and White patients in terms of deaths from cardiovascular disease (CVD) and stroke, potentially reflecting improvements in access and care, according to a letter published in the Journal of the American College of Cardiology.

With rural areas seeing considerably higher rates of CVD mortality compared with urban centers, various initiatives have aimed to level the racially disparate playing field inherent to health care in the United States. It remains uncertain, however, whether such efforts have successfully reached and affected rural areas’ Black residents in the same positive manner as that observed in urban areas.

Investigators examined changes in mortality rates for these 4 identified causes of death, in Black vs White populations in both urban and rural areas, utilizing 1999-2018 data from the Centers for Disease Control and Prevention Wonder database.

They compared yearly age-adjusted (to the 2000 United States census) Black vs White adult (≥25 years) mortality rates (per 100,000 persons), with stratification according to setting, to assess whether there were differential changes over 2 decades in Black vs White mortality rates when comparing rural and urban areas.

Throughout the study period, both rural and urban areas saw Black patients with significantly higher mortality rates for all 4 conditions compared with White patients (P <.001 for all), although these racial disparities were generally narrower in urban settings than in rural areas.

More specifically, when evaluating urban vs rural changes across 20 years in terms of patient mortality by condition, researchers observed significantly larger mean changes in Black/White mortality differences for both diabetes (-0.94±0.07 vs -0.24±0.1]; P <.001) and HTN (-0.3±0.04 vs -0.09±0.07; P = .03), reflecting continuing substantial racial disparity in rural areas.

Nonetheless, this was not the case with urban vs rural changes in CVD mortality (-3.21±0.26 vs -3.65±0.34; P =.46) or stroke mortality (-0.8±0.1] vs -1.35±0.13; P = .02) over this same period, where the racial gap was similarly reduced in CVD mortality, but stroke mortality actually saw significantly greater decreases in racial disparity among rural residents compared with urban dwellers.

Regarding their findings and continued racial disparities, the authors advised, “Targeted public health initiatives are urgently needed to reduce racial inequities in cardiovascular health in rural areas of the United States.”

Disclosure: Several authors declared affiliations with pharmaceutical industry. Please refer to the original article for a full list of authors’ disclosures.


Aggarwal R, Chiu N, Loccoh EC, Kazi DS, Yeh RW, Wadhera RK. Rural-urban disparities: diabetes, hypertension, heart disease, and stroke mortality among black and white adults, 1999-2018. J Am Coll Cardiol. 2021;77(11):1480-1481.

This article originally appeared on The Cardiology Advisor