Rates of Death from Premature Coronary Artery Disease Rising in Rural Women

April 22, 2020
Patrick Campbell

New analysis of nationwide mortality statistics from the CDC is shedding light on an alarming trend among women in rural areas across the US.

Despite advances in recent decades in the battle against cardiovascular disease, new research suggests deaths from premature coronary artery disease (CAD) among rural women have been on the rise since 2009.

Analysis of more than 20 years of data from the Centers for Disease Control and Prevention (CDC) indicated deaths from CAD have increased 11.2% from 2010-2017 in women 55-64 years old, while also uncovering trends related to the disease in other age groups.

”Women living in rural areas of the United States have for the first time suffered an increase in premature deaths from coronary artery disease. This is in stark contrast to their urban counterparts, who have experienced a virtually uninterrupted reduction in premature coronary artery disease deaths,” said lead investigator Federico Moccetti, MD, an interventional cardiologist at Heart Centre Lucerne in Switzerland and former research fellow at Oregon Health and Sciences University, in a statement.

Using multiple-cause-of-death files from the CDC WONDER database from 1999-2017, Moccetti and colleagues at the Knight Cardiovascular Institute sought to assess the impact of CAD in women younger than 65 years old and men younger than 55 years old as well as urban-rural differences of the disease. Through the use of Joinpoint regression modeling, the aim of the current study was to calculate variations in estimated annual percentage change (EAPC) among a multitude of subgroups.

Results of the analysis indicated declines in age-adjusted mortality from premature CAD were similar among men and women from 1999-2010—when rates of decline among women overall began to slow. Further analysis revealed rates of decline in premature CAD mortality became stagnant in rural areas.

When stratifying data according to age, investigators found increases in CAD mortality in rural women 55-64 years old from 2010-2017 (EAPC, 1.4%; 95% CI, 0.2%-2.5%). Additionally, results suggested a similar increase among women aged 45-54 years since 1999 (EAPC 0.6%; 95% CI, 0.2%-1.0%). In 2017, the mortality rate for rural women 35-64 years old was 37.6 per 100,000 compared to 20.7 per 100,000 among women living in a metropolitan area in the same age group—a relative difference of 45.5%.

In the aforementioned statement from the American Heart Association, Moccetti notes the increases seen in the current study represent long-term impacts of failure to adhere to lifestyle guidance over long periods of time.

“Blockages in the heart don’t happen overnight. They are the result of decades of exposure to cardiovascular risk factors such as smoking, high blood pressure, high cholesterol, diabetes, obesity, a sedentary lifestyle and poor diet,” Moccetti said, in the aforementioned statement. “Since the increase in deaths is among younger women, this means that it is the result of exposure to risk factors that occurred during young adulthood, adolescence and even childhood.”

Investigators noted multiple limitations within their study, such as reliance on death certificates and the inability to account for competing risk. However, investigators also highlighted their study encompasses the entirety of deaths from CAD during the study period.

This study, “Increasing Mortality From Premature Coronary Artery Disease in Women in the Rural United States,” was published in the Journal of the American Heart Association.