Provider Density and Systemic Contributors to Rural Cardiovascular Disease Mortality in New England

PurposeRural communities face substantial challenges in accessing healthcare, which contribute to worse outcomes, particularly among patients with chronic heart disease. Rural disparities in cardiovascular disease (CVD)-related mortality may be compounded by limited access to primary care and specialist providers. This study aims to quantify the relationship between CVD-related mortality and the availability of primary-care (PCP) and specialist providers in rural and non-rural areas of New England. MethodsThis study examined associations between county-level provider density and mortality rates for inpatient heart failure (HF) at 154 New England hospitals and heart attacks (HA) at 99 New England hospitals. I assessed rural/non-rural differences in provider densities and mortality using t-tests. I used multivariable linear models to regress mortality rates onto rurality, provider density, and socioeconomic variables. ResultsRural spaces had a lower density of cardiologists (B=-0.522, 95% CI [-0.809, -0.234], p<.001) but not PCP density (B=-0.008, 95% CI [-0.313, 0.304], p=.973). Rurality was also associated with higher 30-day inpatient HF mortality rates after controlling for covariates (B=0.492, 95% CI [0.185, 0.828], p=.005); this was not true for inpatient HA mortality (B=0.348, 95% CI [-0.416, 1.005], p=.266). Cardiologist density was significantly associated with HF mortality in unadjusted models (B=-0.398, 95% CI [-0.586, -0.208], p<.001) but not adjusted (B=-0.079, 95% CI [-0.348, 0.162], p=.479). ConclusionThere exists an intersection between socioeconomic gradients and rurality, underscoring the importance of addressing structural inequities to reduce rural health disparities. Targeted innovations in the recruitment and support of specialist physicians in rural spaces would reduce heart failure mortality.