Social Conditions Linked to Poorer Heart Health in Rural U.S. Adults Compared to Urban Residents

A new study funded by the National Institutes of Health (NIH) reveals that adults in rural areas of the United States have significantly worse cardiovascular health compared to their urban counterparts. The research, led by scientists from the Beth Israel Deaconess Medical Center and Harvard Medical School, highlights how social and economic conditions play a substantial role in shaping heart health outcomes between these populations.

Using nationally representative data from over 17,000 adults aged 20 to 64, researchers found that those living in rural communities had a higher prevalence of several cardiovascular risk factors, including high blood pressure, obesity, diabetes, and high cholesterol. Heart disease itself was almost twice as common in rural adults (7%) compared to urban adults (4%).

These differences were particularly pronounced among young adults aged 20 to 39, a group not typically considered high-risk. Rural residents in this age group were more likely to be living in poverty, have lower levels of education, experience food insecurity, and lack stable housing or homeownership—all of which contributed significantly to their poorer cardiovascular health.

Interestingly, the study found that health behaviors like smoking, physical inactivity, and dietary habits, as well as access to healthcare services, did not fully explain the disparities. Instead, social determinants of health—conditions in which people are born, grow, live, and work—accounted for most of the differences in outcomes.

The regional impact of these findings was also notable. The South showed the widest rural-urban cardiovascular health gap, followed by the Northeast. These results suggest a need for more targeted public health strategies that focus not only on individual behaviors, but also on broader economic and social issues affecting rural populations.

The study underscores the importance of considering social context when addressing health inequities. With more than 60 million Americans living in rural areas—and heart disease remaining the leading cause of death in the U.S.—intervening on the root causes of poor cardiovascular health could be vital to reducing disparities and improving outcomes nationwide.

References

Liu M, Marinacci LX, Joynt Maddox KE, Wadhera, RK. Cardiovascular Health Among Rural and Urban US Adults—Healthcare, Lifestyle, and Social Factors. JAMA Cardiol. 2025; doi: 10.1001/jamacardio.2025.0538(link is external)