Abstract 15361: Rurality and Characteristics of Participants With Heart Failure in the Reasons for Geographic and Racial Differences in Stroke (Regards) Study

Abstract

Introduction: Individuals living with heart failure (HF) in rural settings have higher age-adjusted mortality than urban dwelling individuals. Thus, we sought to examine sociodemographic and clinical differences between rural and urban populations with HF to better understand this disparity. Methods: We examined participants from the REasons for Geographic and Racial Differences in Stroke (REGARDS) population-based cohort who completed a computer-assisted telephone interview (CATI) 10-years following initial recruitment, and who either self-reported a history of HF or had an adjudicated HF hospitalization prior to the CATI. Rural and urban designations utilized a dichotomized adaption of the Rural Urban Commuting Area. We compared sociodemographic and clinical characteristics between rural/urban participants. Logistic regression was used to examine the association between depression and health literacy with urban dwelling. Results: A total of 1002 participants had self reported HF or an adjudicated HF hospitalization during approximately 10 years of follow-up, of which 195 (19%) were classified as rural. Rural dwelling participants with HF were younger (73.5 vs 75.4 years; p=0.004) and more likely to live in the stroke belt (45% vs 33%; p<0.001), earn <$20,000/year (27% vs 20%; p=0.030), experience depressive symptoms (52% vs 45%; p=0.05), and have low health literacy (24% vs 16%; p=0.02). Rural dwelling was associated with higher odds of low health literacy (aOR 1.79, CI 1.07-3.01; p=0.017) and depressive symptoms (aOR 1.13, CI 0.78-1.63; p=0.52). Conclusions: Rural dwelling participants with HF have a lower income and education than urban dwellers. Living in a rural setting was associated with a higher odds of having low health literacy, and half of rural dwelling participants with HF experience depressive symptoms. Addressing these factors may reduce rural/urban disparities in HF outcomes.