Heart Disease in Rural U.S. Rising Among Younger Adults

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From 2010 to 2022, there was a 21% increase in death from heart disease among rural adults ages 25 to 64, with a major spike beginning in 2020. A study — the first national analysis of heart disease in rural areas during COVID-19, and published online in late 2024 in the Journal of the American College of Cardiology — found that cardiovascular mortality increased by 8.1% for people living in rural areas between 2019 and 2022, compared with an increase of 3.6% for those in urban locations.

Several factors are thought to contribute to this sobering rise. Americans who live in rural areas, defined as counties with fewer than 50,000 people, often have a lack of access to health care — including widespread shuttering of local hospitals. This lack was worsened by the pandemic as active hospitals were strained and people were afraid to seek medical care. Poor internet access across swaths of the rural landscape also makes virtual telehealth services unfeasible.

Speaking to NBC News about the study, Dr. Chris Longenecker noted that obesity, hypertension and diabetes have been increasing among working-age adults over the last ten years — with disproportionately higher numbers outside urban areas. Longenecker, director of the University of Washington in Seattle’s global cardiovascular health program, connects the rise to systemic problems like less access to fresh food and gyms, less robust health education and higher unemployment rates.

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The pandemic also contributed to an overall rise in deaths from heart disease, stroke and substance abuse. Indeed, small towns across rural America have been particularly impacted by the opioid crisis — and stimulant use wreaks havoc on the cardiovascular system.

Senior author of the study, Dr. Rishi Wadhera, cardiologist at Boston’s Beth Israel Deaconess Medical Center, said, “It is inexcusable for young adults to be experiencing an increase in cardiovascular death rates anywhere in this country.”

The University of West Virginia, in a largely rural state, is attempting to counter the trend by purchasing struggling area hospitals, hiring more nurse practitioners and physicians assistants, and sponsoring visas for more foreign doctors to come to the area. Dr. George Sokos, the university’s cardiology department chair, noted the difficulties of being able to reach patients early enough, and the importance of “getting to the ground and getting to the patients to deliver basic care.”

Ideally, the efforts of the University of West Virginia will succeed in reaching vulnerable populations before it’s too late — and spur similar changes to reverse the course of increasing heart disease in rural America. Indeed, in the richest nation in the world, it is deplorable that anyone should see their life cut short due to something as preventable as access to care.