University of Louisville
Geographic Variation of Urban-Rural Differences in Cardiovascular Mortality Across States
Grade Level at Time of Presentation
Senior
Major
Public Health
Minor
Biology and Health Management
Institution 24-25
University of Louisville
KY House District #
092
KY Senate District #
31
Faculty Advisor/ Mentor
Shuoyang Wang, PhD; Beatrice Ugiliweneza, PhD
Department
Department of Anatomical Sciences and Neurobiology
Abstract
Background: Cardiovascular disease (CVD) is one of the greatest threats to health today, but its burden is not equally distributed. Rural areas often have lower rates of healthcare access and higher burdens of disease than urban areas. More studies evaluating differences in rural-urban CVD mortality at the state level in recent years are needed.
Hypothesis/Objective: Compare CVD mortality between rural and urban states while exploring factors of access to health care in these states.
Methods/Results: Each state’s rural percentage was defined as its’ population proportion not living in Census Urbanized Area or Urban Cluster. The states were then classified into four quartiles based on the distribution of their rural percentages: 0th-25th percentile rural population (Quartile 1, most urban, n=12), 26th-50th percentile (Quartile 2, n=13), 51th-75th percentile (Quartile 3, n=12), and 75th-100th percentile (Quartile 4, most rural, n=13,). The Centers for Disease Control and Prevention’s Wide-ranging ONline Data for Epidemiologic Research (CDC WONDER) was used to extract CVD death rates for each state. The census data was used to extract percent uninsured and percent households under the poverty level for each state. We compared the CVD mortality rates of Quartile 1 and Quartile 4 using the Chi-Square test.
Highly rural states had significantly higher rates of CVD mortality (285 + per 100,000 people) compared to highly urban states (239 + 0.1 per 100000 people, p < .0001). Highly rural states that also had a high percent household under the poverty level (states in the Southeast) had the highest CVD mortality. Highly rural states without a high percent household under the poverty level (states in the Midwest) had low CVD mortality. We did not observe a correlation between state rural, uninsured population, and CVD mortality percentages.
Conclusion: Overall, the highly rural states had greater rates of CVD mortality than highly urban states. However, the highest mortality rates were observed in states that were highly rural and had high rates of poverty as well. This can be used to inform state policy to better fit the needs of constituents across the United States.
Geographic Variation of Urban-Rural Differences in Cardiovascular Mortality Across States
Background: Cardiovascular disease (CVD) is one of the greatest threats to health today, but its burden is not equally distributed. Rural areas often have lower rates of healthcare access and higher burdens of disease than urban areas. More studies evaluating differences in rural-urban CVD mortality at the state level in recent years are needed.
Hypothesis/Objective: Compare CVD mortality between rural and urban states while exploring factors of access to health care in these states.
Methods/Results: Each state’s rural percentage was defined as its’ population proportion not living in Census Urbanized Area or Urban Cluster. The states were then classified into four quartiles based on the distribution of their rural percentages: 0th-25th percentile rural population (Quartile 1, most urban, n=12), 26th-50th percentile (Quartile 2, n=13), 51th-75th percentile (Quartile 3, n=12), and 75th-100th percentile (Quartile 4, most rural, n=13,). The Centers for Disease Control and Prevention’s Wide-ranging ONline Data for Epidemiologic Research (CDC WONDER) was used to extract CVD death rates for each state. The census data was used to extract percent uninsured and percent households under the poverty level for each state. We compared the CVD mortality rates of Quartile 1 and Quartile 4 using the Chi-Square test.
Highly rural states had significantly higher rates of CVD mortality (285 + per 100,000 people) compared to highly urban states (239 + 0.1 per 100000 people, p < .0001). Highly rural states that also had a high percent household under the poverty level (states in the Southeast) had the highest CVD mortality. Highly rural states without a high percent household under the poverty level (states in the Midwest) had low CVD mortality. We did not observe a correlation between state rural, uninsured population, and CVD mortality percentages.
Conclusion: Overall, the highly rural states had greater rates of CVD mortality than highly urban states. However, the highest mortality rates were observed in states that were highly rural and had high rates of poverty as well. This can be used to inform state policy to better fit the needs of constituents across the United States.