Abstract 13292: Rural-Urban Differences in Mortality Rate of Myocardial Infarction and Heart Failure: A Systematic Review and Meta-Analysis

Abstract

Introduction: Studies indicate that living in a rural area may be associated with worse health outcomes. However, it is unclear whether rurality is associated with mortality in patients with acute myocardial infarction (AMI) and heart failure (HF). This systematic review and meta-analysis aimed to evaluate rural-urban differences in mortality rate after AMI or HF. Methods: A systematic search was conducted for studies published till May 1, 2022 in PubMed, Embase and CENTRAL. Included studies compared mortality rates after hospital admission for AMI or HF in rural versus urban areas. Follow up ranged between 30 days and 3 years. Adjusted Odds ratios (aORs) were pooled with a random-effects model. Results: Six cohort studies were identified, which included 785,156 patients (128,990 in rural vs. 656,166 in urban) with AMI and 1,159,000 patients (192,749 in rural vs. 966,251 in urban) with HF. Compared with urban, patients admitted with AMI in rural areas had higher mortality rates (16% vs 14%, aOR 1.12, 95% Confidence Interval (CI) 1.05-1.20; p =0.0003, I 2 =75%). Compared with urban, patients admitted with HF in rural areas had higher mortality rates (21% vs 18%, aOR 1.19, 95% CI 1.03-1.38; p =0.02, I 2 =90%). (Figure) Conclusions: Among patients with AMI or HF, living in rural areas is associated with an increased risk of mortality. Clinical and policy efforts are needed in order to reduce disparities in rural health.