Many People at Risk of Heart Disease Live in Counties Without a Single Cardiologist
Key takeaways:
GoodRx Research and collaborators from Harvard Medical School find that nearly half of U.S. counties don’t have a single cardiologist.
Counties without a cardiologist (“cardiologist deserts”) are more likely to be rural, have higher rates of uninsured people, and face greater risk of heart disease.
Telemedicine and programs that incentivize cardiologists to work in these counties can help slow rates of heart disease there.
For nearly a decade, heart disease has been one of the leading causes of death in the U.S. In 2022 alone, there were over 700,000 reported heart disease-related deaths.
Cardiologists focus on diagnosing and treating conditions of the cardiovascular system. They are instrumental in reducing deaths from heart disease. Cardiologists don’t exclusively provide cardiovascular care. But patients with heart disease who are treated by a cardiologist may have better health outcomes than those who see other specialists.
Unfortunately, not all Americans have access to these critical healthcare professionals.
New data from the GoodRx Research team and researchers from Harvard Medical School shows that nearly half of U.S. counties do not have a single cardiologist. Many of these counties are rural and have a higher risk of cardiovascular disease. The study was published in the Journal of the American College of Cardiology.
Below, we walk you through our findings and highlight “cardiologist deserts” — areas of the country in urgent need of cardiology care.
Nearly half of U.S. counties lack a cardiologist
To determine if cardiologists were equally accessible across U.S. counties, we used county-level estimates of practicing cardiologists. We obtained this data from Healthlink Dimensions, an independently audited healthcare professionals database.
We identified 1,454 counties with no practicing cardiologist in 2023 (shown in the map below). This amounts to 46% of all U.S. counties, which are home to 22 million residents. Many of these counties are located in the Southern U.S., an area reported to have lower levels of ideal heart health.
Counties without cardiologists are also more likely to be rural. In fact, 86% of entirely rural counties do not have a single cardiologist and are more likely to lack other types of healthcare professionals, including primary care providers. On top of that, they have poor internet access, limiting telemedicine options. These issues can make accessing proper heart healthcare even more difficult.
Counties without a cardiologist also have a greater risk of heart disease and more cardiovascular-related deaths
To determine the heart disease risk for adults living in cardiologist deserts, we created a “cardiovascular risk index” using five known risk factors reported in the 2023 CDC PLACES dataset. These factors were Type 2 diabetes, obesity, smoking, high blood pressure, and high cholesterol.
The map below shows that many counties without a cardiologist have above-average rates of at least one cardiovascular risk factor. Many cardiologist desert counties in the South have higher risk of heart disease due to above-average rates of multiple risk factors.
The darkest-shaded counties have above-average rates of all five heart disease risk factors, while also lacking any practicing cardiologist.
As shown in the chart below, counties without a cardiologist have a higher rate of all risk factors compared to counties with a cardiologist.
Many cardiologist desert counties in the South also have high cardiovascular-related death rates. In fact, counties with the highest cardiovascular-related death rates per 100,000 are in the South, and include Franklin and Madison parishes in Louisiana. These counties had 531 and 503 deaths per 100,000 in 2023, respectively. Likewise, Tunica and Leflore counties in Mississippi had 502 and 490 deaths per 100,000, respectively, and Coal County in Oklahoma had 488 deaths per 100,000. These are prime areas in need of cardiologists.
In addition, we found that the age-adjusted cardiovascular mortality rate per 100,000 is higher in counties without a cardiologist than in counties with a cardiologist (281.6 versus 269.0). What’s more, life expectancy is lower in counties without a cardiologist than in counties with a cardiologist (76.4 versus 77.3 years). Finally, counties without a cardiologist have a lower median household income and a higher rate of uninsured people than counties with a cardiologist.
Taken together, these results suggest that counties without a cardiologist have a higher disease burden than counties with a cardiologist. This translates to higher cardiovascular-related deaths.
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Further, our findings confirm that the ability to see a cardiologist is not equal in all counties, and we need to increase access to this group of specialists in areas such as the South, which appear to be the most at risk.
The bottom line
Cardiologists aren’t the only ones who offer cardiovascular care. But there is evidence that patients with heart disease may have better outcomes when cardiologists treat them.
As heart disease continues to lead U.S. mortality rates, we need to make access to cardiologists more equitable. We can start with policies that incentivize specialists to practice in areas where they’re most needed and increase access to telehealth services and other healthcare infrastructure.
Read about our study methods and all of our findings in the research letter published in the Journal of the American College of Cardiology.
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References
Centers for Disease Control and Prevention (2024). CDC WONDER.
Centers for Disease Control and Prevention (2024). Leading causes of death.
Centers for Disease Control and Prevention (2024). PLACES: Local data for better health, county data 2023.
Go, A. S., et al. (2000). A systematic review of the effects of physician specialty on the treatment of coronary disease and heart failure in the United States. The American Journal of Medicine.
Kim, J. H., et al. (2024). Geographic disparities in access to cardiologists in the United States. Journal of the American College of Cardiology.
Parcha, V., et al. (2021). Geographic variation in cardiovascular health among American adults. Mayo Clinic Proceedings.
