Prevalence and incidence of myocardial infarction and heart failure: An urban-rural comparison

Context: Cardiovascular disease, including myocardial infarction (MI) and heart failure (HF), is highly prevalent and remains the leading cause of death in the U.S. Rural/Urban disparities have been shown across numerous health and healthcare factors; however, disparities in the MI and HF among the elderly have not been fully considered.

Objective: To estimate the differences in prevalence and incidence of MI and HF between urban and rural elderly Medicare beneficiaries.

Methods: Cross sectional analyses of Medicare Current Beneficiary Survey (MCBS) from 2001 to 2005. Descriptive and bivariate analyses were conducted to compare the prevalence and incidence of MI and HF between urban and rural elderly Medicare beneficiaries. Sampling weights were used so that the analysis would be nationally representative.

Findings: Rural beneficiaries experienced about 15% higher MI prevalence than their urban counterparts (15% vs 13%), p<0.05 for each of the 5 years. The difference in one year MI incidence was statistically significant for 2003 at p<0.05 and for 2004 and 2005 at p<.10. Rural beneficiaries experienced almost 50% higher HF prevalence compared to their urban counterparts (9% vs 6%), p<0.05 throughout 2003-2005. (HF prevalence data is not available for 2001 and 2002.) One year HF incidence was also almost 50% higher (3.3% vs 2.2%) for rural Medicare beneficiaries, p<0.05 throughout 2002-2005.

Conclusions: There is evidence that elderly rural Medicare beneficiaries have higher prevalence and one year incidence of MI and HF than their urban counterparts. Research is required to identify the risk factors contributing to the difference.