The University of Toledo Translation Journal of Medical Sciences 
Hospital Medicine Abstract, Department of Medicine Research Symposium UTJMS 2023 May 5; 11(1):e1-e1 

Urban-rural Disparities in Trends of 
Pulmonary Hypertension-Related Mortality 
in the United States, 2004-2019 

R Issa1*, AMK Minhas1; RW Ariss2; S Nazir1; DI Sattie1; M Ali1; A Mahmood1 

1Division of Hospital Medicine, Department of Medicine, The University of Toledo, 
Toledo, OH 43614 
2Division of Gastroenterology and Hepatology, Department of Medicine, The 
University of Toledo, Toledo, OH 43614 

*Corresponding author: Rochell.Issa@utoledo.edu

Published: 05 May 2023

Introduction: Despite medical advances that have extended life expectancy in pulmonary hypertension 
(PH) patients over the past few decades, mortality has continued to be high within the United States. 
Yet, there is a paucity of research regarding rural-urban disparities associated with PH mortality, with 
trends only being reported prior to 2011.    

Methods: We extracted PH-related urban-rural deaths from 2004 to 2019 from the Centers for Disease 
Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research (CDC WONDER). 
Crude and age-adjusted mortality rates (CMR and AAMR) per 100,000 people were calculated. 
Associated average percentage changes (APC) were computed using Joinpoint trend analysis software 
and reported as average annual percent changes (AAPCs).    

Results: A total of 353, 916 pulmonary hypertension-related deaths occurred in the study population 
within the US between 2004 and 2019. The AAMR for overall PH increased from 8.19 in 2004 to 11.63 
in 2019. Rural counties had an overall significantly higher AAMR than urban counties, (rural: 10.75 
[95% CI, 10.67 to 10.84] versus (urban: 9.70 [95% CI, 9.66 to 9.74].   

Conclusion: Overall, our results indicate a gap in PH-associated healthcare services among those living 
in rural counties as compared to those living in urban counties within the US. 

https://dx.doi.org/10.46570/utjms.vol11-2023-748 

https://dx.doi.org/10.46570/utjms.vol11-2023-748
mailto:Rochell.Issa@utoledo.edu