Rural–urban differences in mortality from concurrent heart failure and cancer, 2011–2020

Abstract Rural populations experience higher mortality rates than urban populations for both heart failure (HF) and cancer, however, mortality involving both conditions has not been well characterized. We evaluated national trends and demographic differences in HF-related and HF + cancer–related deaths and assessed rural–urban disparities. Using U.S. death certificate data from 2011 to 2020, we calculated age-adjusted mortality rates (AAMRs) per 100,000 persons for HF-related and HF + cancer–related deaths overall and stratified by rurality. During the study period, 3,453,655 HF-related deaths occurred, of which 274,715 (8%) also involved cancer. AAMRs increased over time for both outcomes. Rural areas consistently demonstrated higher mortality rates than urban areas for HF-related deaths (143.2 vs 110.1 per 100,000) and HF + cancer–related deaths (11.6 vs 8.8 per 100,000). Rural–urban disparities were evident across sex, age, and race/ethnicity groups. The largest rural-to-urban AAMR ratios were observed for lung/bronchus cancer (1.41), colorectal cancer (1.39), and leukemia (1.32). Mortality associated with both HF and cancer disproportionately affects rural populations. These findings highlight a growing dual burden of cardiovascular disease and cancer in rural communities and underscore the need for targeted prevention and care strategies addressing multimorbidity in these settings.