Rurality, Death, and Healthcare Utilization in Heart Failure in the Community

Abstract

Background Prior reports indicate that living in a rural area may be associated with worse health outcomes. However, data on rurality and heart failure (HF) outcomes are scarce. Methods and Results Residents from 6 southeastern Minnesota counties with a first‐ever code for HF ( International Classification of Diseases, Ninth Revision [ ICD‐9 ], code 428, and International Classification of Diseases, Tenth Revision [ ICD‐10 ] code I50) between January 1, 2013 and December 31, 2016, were identified. Resident address was classified according to the rural‐urban commuting area codes. Rurality was defined as living in a nonmetropolitan area. Cox regression was used to analyze the association between living in a rural versus urban area and death; Andersen‐Gill models were used for hospitalization and emergency department visits. Among 6003 patients with HF (mean age 74 years, 48% women), 43% lived in a rural area. Rural patients were older and had a lower educational attainment and less comorbidity compared with patients living in urban areas ( P <0.001). After a mean (SD) follow‐up of 2.8 (1.7) years, 2440 deaths, 20 506 emergency department visits, and 11 311 hospitalizations occurred. After adjustment, rurality was independently associated with an increased risk of death (hazard ratio [HR], 1.18; 95% CI, 1.09–1.29) and a reduced risk of emergency department visits (HR, 0.89; 95% CI, 0.82–0.97) and hospitalizations (HR, 0.78; 95% CI, 0.73–0.84). Conclusions Among patients with HF, living in a rural area is associated with an increased risk of death and fewer emergency department visits and hospitalizations. Further study to identify and address the mechanisms through which rural residence influences mortality and healthcare utilization in HF is needed in order to reduce disparities in rural health.

Association of Rurality With Risk of Heart Failure

“…Prior research on HF within rural communities has focused mainly on mortality outcomes . However, research on HF incidence among rural residents within the United States is relatively limited.…”

“…The University of Washington Rural Health Research Center provides code aggregation for use in health research. For this study, RUCA codes were grouped based on categorization C (eTable 2 in Supplement 1), consistent with prior research characterizing HF and rurality …”

“…Black men living in rural areas, particularly the rural South, are more likely to die of HF compared with Black men in urban areas and White men in both rural and urban areas . Whether these inequities reflect higher HF incidence is less understood . Addressing this question is critical to develop interventions to reduce rural-urban disparities.…”

Disparities in Cardio-oncology: Effects On Outcomes and Opportunities for Improvement

“…Striking differences exist in the rural and urban populations that affect healthcare access and quality of life. In a study of 6,003 HF patients, rurality was associated with fewer emergency department visits and an increased risk of death [ 41 ]. Another study followed 81,418 patients with solid organ cancers and baseline CVD in a Canadian Province for at least one year where rurality, low income, and low education were associated with higher odds of developing new CVD [ 42 ].…”

Bivariate Stochastic Simultaneous Differential Equation Model for Heart Failure

“…Heart failure is a significant public health burden, with an estimated 2 million people suffering from heart failure worldwide. Such patients are at high risk of death without advanced therapies like ventricular assist devices, heart transplantation, etc [1,2,3,4]. So, the modeling the heart failure remains an important field of research that helps to understand the underlying mechanisms of the disease progression and recovery process [5].…”