The increased risk of early death after a heart disease diagnosis is a multifaceted issue. In 2021, the American Heart Association (AHA) released research findings from a study published in the scientific journal Circulation that highlighted how adults who live in what the researchers termed “socially vulnerable” regions of the U.S. were more susceptible to premature death from heart disease. Socioeconomic status, race, disability, and housing conditions were a few of the various factors that the researchers incorporated into their definition of socially vulnerable.

In comparison to people living in less vulnerable regions, the researchers found that Americans residing in more vulnerable counties (the majority of which were in the southeast or southwest regions of the country) were over 80% more likely to die from heart disease before the age of 65. More specifically, the risk of early death due to cardiovascular disease was two to five times greater for people living in rural counties than for people dwelling in urban environments.

“Emerging studies suggest that conditions in the places where people live, learn, work and play — called social determinants of health — contribute to higher risk of premature death for people living in socially vulnerable communities,” study author Dr. Khurram Nasir told the AHA in a press release.