Objectives: Regional and urban-rural disparities in premature coronary heart disease (CHD) mortality were evident in the US as early as 1950. Recent favorable trends at the national level may obscure less favorable outcomes for certain regions and localities. The authors examined trends in premature CHD mortality for 1985-1995 for black and white adults ages 35-64 years for four categories of urbanicity in two regions of the US (South and non-South).
Methods: All counties in the US (excluding Alaskan counties) were grouped by urbanicity and region. Annual age-adjusted CHD mortality rates were calculated for adults ages 35-64 by racial category (African American or white) and gender for each geographic area for the years 1985- 1995. Loglinear regression models were used to estimate average annual percent declines in mortality for each of 28 geo-demographic groups. Data were also collected on selected socioeconomic resources by urbanicity for the non-South (excluding Alaska) and South.
Results: For both white and black adults ages 35-64, the highest rates of premature CHD mortality and slowest mortality declines were observed in the rural South. For white men and women, marked disparities in premature CHD mortality across categories of urbanicity were noted in the South but not outside the South. Unexpectedly high rates of premature CHD mortality were observed for African Americans in major metropolitan areas outside the South despite favorable levels of socioeconomic resources.
Conclusions: Disparities in premature CHD mortality by region and urbanicity appear to have widened between 1985 and 1995. Residents of the rural South had the highest rates of premature CHD mortality, and rural communities in the South face significant barriers to effective heart disease prevention and control.