Location, Location, Location: The Rural Urban Divide

When I think about the social determinants of health, race, gender, socio-economic status and zip code immediately come to mind. Having practiced medicine in Sacramento and Portland at hospitals with large catchment areas, I have taken care of numerous patients from rural areas. In her talk at the Lancet Commission Educational Symposium in New York, titled “Social determinants of health- how to improve access to cardiovascular care for all women” immediate past-president of ACC Dr. Dipti Itchhaporia, M.D., MACC , FAHA, FES encouraged me to think more critically about our patients’ environments.

Specifically, Dr. Itchhaporia presented compelling data describing the rural urban divide. In a cross-sectional examination of 248,731 AF admissions, patients admitted to rural hospitals had a 17% increased risk of death after a multivariable model adjusting for confounders (OR=1.17, 95% CI=1.04, 1.32).(1) In a study investigating age-adjusted mortality rates by rural-urban status, heart failure (HF) related deaths were significantly higher for residents in rural compared with urban counties with rural black men having the highest HF mortality.(2)

In her editorial, titled “Navigating the Path to Digital Transformation” Dr. Itchaaporia defines digital transformation as “the positive integration of digital technology into all aspects of health care that requires interaction with patients and clinicians.”(3) Throughout the conference she emphasized the need for digital transformation and even highlighted what we can learn from efforts in countries such as India with a large rural population with significant barriers to care. Clearly, improving care and outcomes for our rural patients goes beyond virtual visits and will require us to rise together, challenge our current standards and actively engage in innovation.

Dr. Pooja Prasad is a cardiology Fellow at Oregon Health & Science University in Portland, Oregon, CardioNerds fellow ambassador, and was CardioNerds Conference Scholar for the RISE 2023 conference hosted by Women as One.

  1. O’Neal WT, Sandesara PB, Kelli HM, Venkatesh S, Soliman EZ. Urban-rural differences in mortality for atrial fibrillation hospitalizations in the United States. Heart Rhythm. Feb 2018;15(2):175-179. doi:10.1016/j.hrthm.2017.10.019
  2. Pierce JB, Shah NS, Petito LC, et al. Trends in heart failure-related cardiovascular mortality in rural versus urban United States counties, 2011-2018: A cross-sectional study. PLoS One. 2021;16(3):e0246813. doi:10.1371/journal.pone.0246813
  3. Itchhaporia D. Navigating the Path to Digital Transformation. J Am Coll Cardiol. Jul 27 2021;78(4):412-414. doi:10.1016/j.jacc.2021.06.018