Study: More Americans ages 18-54 are dying from severe first heart attacks

Even some 35-year-olds are at risk for severe heart
attacks. (Photo by E. Akurt, Unsplash)

Death by heart attack used to be a worry for only older Americans, but a new study revealed an alarming increase in heart attack deaths among younger Americans. The results are particularly worrisome for younger rural Americans who tend to have less access to preventative medical treatment, are more likely to smoke cigarettes and often face longer drives to reach emergency care. 

"The proportion of adults ages 18 to 54 who died in a hospital of a severe first heart attack rose 57% between 2011 and 2022, according to the study published in the Journal of the American Heart Association," reports Betsy McKay of The Wall Street Journal. The study data showed that more than 75% of severe heart attack deaths were men, and 71% were between the ages of 45 and 54 years.

The increase in heart attacks deaths is yet another indicator younger Americans aren't as healthy as previous generations. McKay writes, "Poorer health among younger adults is one reason heart disease remains the leading cause of death in the U.S."

Americans who died after a heart attack often had other underlying chronic health issues or smoked. "About 60% had high blood pressure, while more than half also had high cholesterol and smoked. About a quarter had diabetes."

Younger adults need to be warned that the risk of heart attacks can begin "as early as age 35," McKay adds. "Younger people could use a risk calculator on the AHA’s website." Experts recommend using the 30-year estimate rather than a 10-year one for greater accuracy.

Food and Drug Administration considering product 'warning labels' to help Americans make healthier choices

Food sold in some Latin countries features bold
warning labels. (Adobe Stock photo)

To help Americans improve their diets, the Food and Drug Administration is "considering requiring food manufacturers to put new labels on the front of packages," report Andrea Petersen and Jesse Newman of The Wall Street Journal. "The labels might flag certain health risks, such as high levels of salt, sugar or saturated fat."

With the alarming rise in diabetes and cardiovascular disease in the United States, the FDA is exploring distinctive labeling on the front and back of packaging to help Americans make better nutritional choices. "One label idea the FDA has tested uses red, yellow and green to convey whether products are high, medium or low in added sugar, sodium and saturated fat," the Journal reports. "Other potential labels that the FDA has shared state how much of those substances a product contains per serving."

Food industry leaders indicated that they might sue the FDA should the labeling proposal become a rule, claiming the requirement "poses a threat to First Amendment rights and that only Congress has the authority to require it," the Journal reports. "Such labels could unfairly convey that certain foods are bad to eat, when in fact a candy bar may not be healthy, but consuming it in moderation isn't a problem, lobbyists said." Food industry proponents also insist the current labeling system is sufficient.

"The FDA says it intends to propose a rule on the labeling this summer."

So far, studies have supported the FDA's labeling idea. The Journal reports, "Scientific studies have generally found that front-of-package nutrition labels lead people to identify and choose healthier foods. More countries now require them on food and beverage containers. Others, including France, the U.K. and Australia, have voluntary programs."

In Chile, warning labels are put on products, and the country has seen dietary changes for consumers. According to Petersen and Newman, "After the warning labels were implemented, food manufacturers changed their products, too — by reducing the amount of sodium or sugar."

Rural residents with diabetes are more likely to suffer from disease complications -- lack of access to care could be why

Diabetes requires continuous care.
(Photo by T. Barbhuiya, Unsplash)

Past studies have shown that rural Americans are more likely to develop type 2 diabetes, and they experienced more struggles trying to manage the disease than their more urban counterparts. In a new study, researchers from the University of Maryland School of Medicine took a closer look at rural residents experiencing diabetes complications such as heart and kidney problems. Their research, which was published in the journal Diabetes Care, showed that these rural populations are at significantly higher risk of suffering from end-stage kidney disease, heart failure and heart attacks, all of which could caused by a lack of access to medical care.

The study's corresponding author, Rozalina McCoy, told UM news: "Those who live in rural areas have a greater risk of experiencing eight out of the eleven complications that we measured compared with those living in cities. . . .They were 15 percent more likely to have dangerously low blood sugar levels, which clearly indicates that their diabetes is not being managed properly."

The study's co-author, Elsa Davis, added, "While our study didn't address why these differences exist, we do know that people living outside of city areas are less likely to receive care from diabetes specialists, to receive diabetes self-management education, and to be monitored for diabetes complications."

While the study encompassed varying degrees of rural populations, it "relied on insurance information to identify diabetes complications," UM reports. "If people could not access medical care, that complication would not be captured. Dr. McCoy noted that this finding further underscored the barriers to care in remote areas: patients are likely having high blood sugar emergencies and heart failure but cannot get to the emergency department or hospital to have them diagnosed and treated." Study authors added that further research should investigate reasons why these disparities exist.

Study finds lower overall death rates in rural hospitals that became part of larger groups, more so with heart attacks

Rural hospitals that became part of larger groups were less likely to have patients die in the hospital, says a new study published in JAMA Network Open, a journal of the American Medical Association.

Researchers with IBM Watson Health and the federal Agency for Healthcare Research and Quality "analyzed data from 172 merged hospitals and 266 comparison hospitals that remained independent from 2009 to 2016," Becker's Hospital Review reports. "Mortality rates dropped from 4.3 percent to 3.2 percent at rural hospitals that completed a merger."

Also, merged rural hospitals saw an even bigger decrease, 4 percentage points, in deaths from heart attacks. "Researchers also found a significantly greater reduction in inpatient mortality for several other common conditions, such as heart failure, acute stroke and pneumonia, among patients admitted to rural hospitals involved in a merger or acquisition than among patients admitted to independent rural hospitals," Becker's reports.

Covid roundup: Pediatric hospitalizations up; Christian broadcasting group's spokesman fired after pro-vax op-ed

Here's a roundup of recent news about the pandemic and immunization efforts:

The number of children hospitalized for Covid-19 has soared over the summer, especially in the least-vaccinated states, leaving some children's hospitals and intensive-care units stretched thin. Read more here and here.

Stillbirths have doubled during the pandemic in Mississippi, the least-vaccinated state. State officials have recorded 72 stillbirths (spontaneous miscarriages after 20 weeks of gestation) among unvaccinated pregnant people who were infected with the coronavirus. Eight infected pregnant people have also died over the past month. Pregnant and recently pregnant people have a higher risk of becoming severely ill from the coronavirus, studies show. Read more here.

The rate of new coronavirus infections among babies and children under age 4 recently surpassed the rate of new cases among seniors. Experts discuss what steps pregnant people and parents can take to be safe. Read more here.

The spokesperson for the National Religious Broadcasters (an association of more than 1,000 Christian new media professionals) was fired at the end of August after encouraging people to get their coronavirus vaccines in a USA Today op-ed and an appearance on MSNBC's "Morning Joe." He was fired for violating the company's policy of staying neutral on vaccination, the CEO said on social media. Read more here.

Crowded jails and prisons drove millions of coronavirus infections, a new study has found. Read more here.

Coronavirus testing, hospital stays and emergency-room visits are about to get much more expensive for many Americans, as major insurers end the temporary waivers that reduced costs. Read more here.

A recent study found that unvaccinated people are 29 times more likely to be hospitalized with Covid-19 than vaccinated people. Many vaccinated people worry about breakthrough infections, but the risk depends on factors such as overall health, where someone lives, and what other risks they take. Vaccinated people who do get infected tend to suffer only mild symptoms, if any. Read more here.

People who have survived a coronavirus infection and then gotten vaccinated have what's called "hybrid immunity," and studies show it's impressively potent—not just against the Delta variant, but possibly future variants as well. Read more here.

Experts say it's especially important to get a flu shot this year: with Covid cases surging across the country, it may be difficult to get treated if you get the flu and it takes a turn for the worse. Also, getting the flu can weaken your immune system and make you more susceptible to coronavirus infection—and getting both viruses one after the other could be dangerous. Read here for more answers to frequently asked questions.

Fully vaccinated people who get a breakthrough coronavirus infection are about half as likely as unvaccinated people to suffer from long Covid, a study has found. Read more here.

A respiratory therapist describes, in seven stages, how Covid-19 typically progresses among hospitalized patients. Read more here.

Experts recommend some tips for coping with pandemic anxiety this fall and winter. Read more here.

The share of American adults willing to get vaccinated rose 5 percentage points in the last month, according to a recent poll. Read more here.

People who were hospitalized for Covid-19 are twice as likely as usual to develop kidney disease afterward, researchers have found. Read more here.

Quick hits: Docuseries explores why people live in rural areas; Biden drops nominee to head ATF after pushback

Here's a roundup of stories with rural resonance; if you do or see similar work that should be shared on The Rural Blog, email heather.chapman@uky.edu.

A seven-part docuseries called "Rural by Choice" tells the story of why people choose to live in rural Minnesota. The first episode will premiere on Sept. 12, with the rest of the episodes premiering each week afterward. Click here for more details, including how to watch.

The White House has withdrawn David Chipman's nomination for director of the Bureau of Alcohol, Tobacco, Firearms and Explosives after sustained pushback over his record of gun-control advocacy. Read more here.

As cell-cultured meat gets ever closer to hitting store shelves, the Agriculture Department's Food Safety and Inspection Service is seeking consumer comments on how such products should be labeled. Suggestions will be accepted until Nov. 2. Read more here.

"In summer 2020, a federal court ruled the Environmental Protection Agency showed too much deference to Bayer when it approved the company’s dicamba herbicide. This invalidated the approval. But, weeks later, Bayer began working the EPA again, according to newly obtained emails," Jonathan Hettinger reports for the Midwest Center for Investigation. Read more here.

Mountain Valley Pipeline developers have filed a subpoena seeking to find out the names and phone numbers of the people who run a Facebook group critical of the project. Read more here.

Local food is all the rage, but what makes food local? Read more here.

A recently published study found that single rural residents with heart disease face more hopelessness. Read more here.

A tech business owner and Columbia University professor discusses why rural students need to learn about artificial intelligence in school and what kind of education and training is needed so they can compete with their suburban and urban peers for high-paying tech jobs. Read more here.

Registration is open for a symposium on sustainable ranching practices. The event will be held Oct. 14-15 in Kingsville, Texas, and online. Read more here.

Scientists are trying to control emerald ash borers with tiny parasitic wasps. The strategy will hopefully go better than previous attempts to kill pests by using other natural predators (see: cane toads) because the wasps they're testing can't sting people and only go after the borers. Read more here.

The Rural Health Information Hub has updated its guide to critical-access hospitals to include two new FAQs on 340B eligibility and Rural Emergency Hospitals. There is also updated info on reimbursement, eligibility, funding, legislation, and more. Read more here.

Study: the more rural a place is, the higher the incidence of stroke risk factors, especially smoking among the poor

It's well-known that rural residents are at a higher risk of stroke. But a newly published study in The Journal of Rural Health examined the trend across rurality and found that, the more rural the place, the higher the prevalence of stroke risk factors such as hypertension, diabetes, heart disease, smoking, poverty, and more. Most interestingly, the study uncovered a link between stroke incidence and higher smoking rates, especially in poorer areas. 

Previous research has found that more rural areas have higher stroke mortality rates than more densely populated areas, but that's mainly because of a higher stroke incidence, not a higher case fatality, the authors write.

That said, health-care access disparities also worsen rural stroke survival rates, a 2020 study found. Small, rural hospitals often can't quickly transfer stroke patients to bigger hospitals with access to more experienced specialists and newer treatments, according to the study. 

Going to daylight saving time this weekend could be especially hard because of pandemic-related sleep loss

"The clock springs forward one hour on Sunday morning, March 14 for most people in the U.S. That is not an appealing thought for those who have suffered sleep problems because of the pandemic," Michael Jaffee writes for The Conversation. "Sleep this past year has been affected by a variety of factors, including anxiety, inconsistent schedules and increased screen time. This affects our health, as getting adequate sleep is important to assure our immune system can fend off and fight infections. Even before the pandemic, about 40% of adults – 50 to 70 million Americans – got less than the recommended minimum seven hours per night."

Scientists are increasingly concerned about how the twice-yearly time change affects people's bodies. "The American Academy of Sleep Medicine, the largest scientific organization that studies sleep, in October 2020 suggested nixing daylight saving time and moving to a year-round fixed time," Jaffee reports. "That way, our internal circadian clocks would not be misaligned for half the year. And it would eliminate the safety risk from sleep loss when transitioning to daylight saving time."

Jaffee, the vice chair of neurology ay the University of Florida, has studied how the lack of sleep can impair the brain, and believes we have cause for concern: "In the 1940s, most American adults averaged 7.9 hours of sleep a night. Today, it’s only 6.9 hours. To put it another way: In 1942, 84% of us got the recommended seven to nine hours; in 2013, it was 59%. To break it down further, a January 2018 study from Fitbit reported that men got even less sleep per night than women, about 6.5 hours."

Lack of adequate sleep can cause more problems than being tired, Jaffee reports. It's associated with higher rates of heart disease, diabetes, obesity, asthma, depression, and lowered memory retention, attentiveness, and ability to fight off infections.

"States advocating for permanent daylight saving time are typically those that rely on tourism," Jaffee reports. "Environmentalists, favoring less energy consumption from morning heating and evening air conditioning, often support permanent standard time. Religious groups, whose prayer times are linked to sundown and sunrise, also tend to prefer permanent standard time. So do many educators, opposed to transporting children to school during mornings when it’s still dark."

New telehealth program aims to help rural patients with chest pain figure out whether they're facing a heart attack

A new health care program in North Carolina—which could be replicated elsewhere—aims to help rural patients with chest pain avoid a potentially unnecessary and expensive trip to the emergency department. 

"The $1.2 million program, slated to begin in mountainous Wilkes County early next year, will bring doctors and nurses to the scene of medical emergencies through telehealth," Liora Engel-Smith reports for North Carolina Health News. "The doctors and nurses — most of them experts in emergency medicine — will help first responders evaluate patients with chest pain to decide the most appropriate next step, be it a hospital visit or a trip to a county health department for further tests."

The program could save both patients and the health-care system a lot of money, said Simon Mahler, professor of emergency medicine at Wake Forest Baptist Health, which helps oversee the program. "Mahler hopes the program will serve as a blueprint for similar initiatives for cardiac patients in other rural corners of North Carolina," Engle-Smith reports. "Heart attacks, strokes and other cardiovascular diseases — the state’s leading causes of death — affect and kill rural residents far more often than their urban counterparts." That's true nationwide as well.

Cardiovascular mortality rate in rural areas keeps declining, but not as much as in metropolitan areas, study finds

The death rate for cardiovascular disease in rural areas continues to decline, but not as much as it has in metropolitan areas, says a study published in the Journal of the American Medical Association.

From 1999 and 2017, age-adjusted death rates for cardiovascular disease declined 4.1 percent in large metropolitan areas, 3.7% in smaller metro areas, and 3.2% in rural counties. Thus, the disparity in death rates urban and rural areas grew; it rose from 24 deaths per 100,000 population in 1999 to 42.8 deaths per 100,000 population in 2017.

The actual rate declines from 1999 to 2017 were: large metros, 347.6 to 208.6; medium and small metros, 343.7 to 221.8; and rural areas, 371.6 to 251.4.

The study involved several researchers from leading institutions and was led by Sarah Cross of the Sanford Institute of Public Policy at Duke University.

One of the co-authors, Dr. Haider J. Warraich, associate director for the heart-failure program at the VA Boston Healthcare System, told United Press International, "This should be a wake-up call for the American people and policymakers. Rural health has been ignored far too long, and the rural health system has not been designed to help patients with chronic conditions like cardiovascular diseases . . . What we need is a more robust outpatient and population-focused healthcare system that incentivizes improvement in outcomes rather than rewards hospitalizations and procedures."

Seniors live longer these days, but not as long in rural areas, and their lifespans lag many other developed nations

Life expectancy for seniors at age 65 increased across the board from 2000 to 2016, but not nearly as much in rural areas, according to a newly published data analysis.

Urban and coastal seniors survive much longer than seniors in rural areas and the nation's interior—especially areas like Appalachia and the East South Central states (Kentucky, Tennessee, Alabama and Mississippi). The geographic gap emerged around 1999 or 2000 and has been widening since 2000, Judith Graham reports for Kaiser Health News.

University of Pennsylvania demographer Samuel Preston spotted the trend using data from the Census Bureau and the National Center for Health Statistics. The longest-living seniors tend to be found in metro areas on the Pacific coast, and the ones with the shortest lifespans live in the rural East South Central states; the life expectancy gap between those two regions was nearly four years.

Men and women had differing life expectancies, according to co-author Yana Vierboom, a researcher at Germany's Max Planck Institute for Demographic Research; by 2016, "life expectancy at age 65 for women in large metropolitan areas was 1.63 years longer than for those in rural areas. For men, the gap was 1.42 years," Graham reports. "Disparities were also highlighted when researchers examined life expectancy at 65 in the U.S. and 16 other developed nations, using 2016 data. Overall, the U.S. was near the bottom of the pack: American men ranked 11th while American women were in 13th place, behind leaders such as Japan, Switzerland, Australia, France, Spain and Canada."

Preston's study identified a reduction in deaths from cardiovascular illnesses like strokes or heart attacks as the biggest reason Americans are living longer. Such illnesses are the number one cause of death in the United States. Preston speculated that rural seniors might be more apt to die from heart attack or stroke because of lack of medical access, and said smoking rates likely had an impact, too. The study did not consider race, income, or education, which probably play a role, Graham reports.

Some state legislatures tackle rural health access problems

Stateline map; click to enlarge it.

As state legislatures begin their 2020 sessions, more are grappling with how to increase access to medical care in rural areas.

Most rural areas have significantly worse health outcomes than cities and suburbs. Rural mortality rates for the top five causes of death (heart disease, cancer, accidents, low respiratory disease and stroke) and the gap has been growing at least since 2009, Michael Ollove reports for Stateline. Rural areas also have higher suicide rates. And though urban areas have a higher overall rate of deaths from drug overdoses, rural areas have higher overdose rates for some drugs, such as methamphetamines and oxycodone. Rural women are also more likely to die from a drug overdose than their suburban and urban counterparts.

The health gap has multiple reasons: poverty (which reduces access to health insurance and nutritious food), higher rates of smoking and obesity, and lower rates of exercise. Another big reason: "Since 2005, at least 163 rural hospitals have closed, more than 60 percent of them since 2012. Nineteen rural hospitals closed in 2019, the most in a year," according to the Rural Health Research Program at the University of North Carolina, which tracks rural hospital closures, Ollove reports. Rural health clinics are faring poorly, too: 388 clinics closed between 2012 and 2018, leaving 4,245 in operation.

Partly because of hospital closures, rural areas have a hard time attracting and keeping medical professionals. "Nearly 80% of rural counties are short on primary-care doctors, and 9% have none, according to the National Rural Health Association’s Policy Institute," Ollove reports. "The shortage of providers is likely to only get worse. More than 25% of primary care physicians in rural areas are 60 or older, compared with 18% in urban areas.

Though Medicaid expansion and the Patient Protection and Affordable Care Act have helped many rural residents get health insurance, rural areas are still grappling with these systemic problems. "Many states are focused on making improvements, both large and small, to address the deficiencies," Ollove reports. "Among the ideas: creating private-public partnerships to increase access to care, sending mobile medical units into remote areas, expanding telemedicine and encouraging young people in rural communities to go into health professions."

Several Republican-run states are fielding initiatives to expand Medicaid, which would increase rural coverage and thus rural hospitals' revenue. "Some states are trying to help rural hospitals deliver preventive care and chronic illness management beyond their walls, improving the collective health of the community while reducing health care costs," Ollove reports.

Pennsylvania, for example, has an initiative in which it guarantees 13 participating rural hospitals the revenue they'll receive in the coming year and rewards hospitals for keeping patients healthy and out of hospitals. The hope is that hospitals will be better able to focus on prevention and treatment without having to worry so much about the budget, Ollove reports.

"Brock Slabach, senior vice president of the nonprofit National Rural Health Association, said big ideas are needed to truly change the trajectory of rural health. The good news is that because of scale, rural areas are promising places to test out innovations in the delivery and financing of health care." But, he told Ollove, "we don’t have the luxury of having years to spend finding solutions."

Rural doctor's weight-loss clinic sees big results with old-fashioned methods: eat better food, less of it, and exercise

Dr. Carol Peddicord holds a model representing five
pounds of body fat. (Clinton County News photo)

A doctor and a pharmacist in rural Albany, Kentucky are seeing big results in the fight against obesity after opening a weight-loss clinic. Since The Doctor's Health and Weight Loss Clinic opened in January, its 433 patients have lost a collective 4,079 pounds, and most have maintained their weight loss, Brett Gibson of the Clinton County News reports.

Dr. Carol Peddicord and pharmacist Arica Collins of Dyer Drug Co. came up with the idea for the clinic after seeing how many patients came in looking for a quick fix to lose weight. But the best way to do that is to live a healthier lifestyle, not through a pill or a crash diet, the News notes.

The emphasis is on healthier, Peddicord told the News: "We don’t want people to be skinnier, we want them to be healthy and live longer."

Obesity is a significantly bigger problem in rural areas than in suburban and urban areas, according to the Centers for Disease Control and Prevention. Among adults, 34.2% of rural residents are obese, compared with 28.7% in metropolitan counties.

Though the duo first conceived of the clinic because they were worried about children's health, most of their patients are women between 35 and 58. There are a few high schoolers, though, and they're starting to see more men coming in. That's good, Peddicord told the News, because men typically have heart disease earlier in life.

Albany, in Clinton County, Kentucky
(Wikipedia maps)

The clinic, which takes insurance, offers individually tailored wellness plans for patients, depending on whether they have high blood pressure, diabetes, and/or heart disease. They offer diet plans and will soon have plans for meal replacements such as shakes, the News reports.

Though Peddicord was glad to note that the clinic's patients had lost 680 pounds last month, she told the News that pounds aren't the only thing that matter. Patients have seen other "non-scale victories," such as being able to stop taking insulin for diabetes. "People are losing weight, feeling better and are able to exercise," Peddicord said.