Abstract
Background: Female mortality from cardiac dysrhythmias shows striking geographic variation across the U.S., yet the structural drivers of this disparity remain underexplored. Healthcare infrastructure, economic capacity, and access to specialized care may play a critical role.
Objective: To investigate the association between state-level female arrhythmia-related mortality and institutional factors, including gross domestic product (GDP) per capita, number of hospitals, and cardiology fellowship programs.
Methods: Age-adjusted female mortality rates from cardiac dysrhythmias (2019-2021) were obtained from the CDC Atlas of Heart Disease and Stroke. Institutional data included state-level GDP per capita (U.S. Bureau of Economic Analysis), number of hospitals (CMS), and cardiology fellowship programs (AMA FREIDA). States with mortality >21/100,000 (top quintile, n=9) were classified as "high-mortality." Pearson correlation coefficients assessed relationships between mortality and institutional variables.
Results: Across 52 U.S. jurisdictions (50 states, DC, and Puerto Rico), female arrhythmia-related mortality ranged from 6.9 to 28.0 per 100,000 (Figure-1). Hospital count per state showed a significant inverse correlation with mortality (r = -0.45; p < 0.01). Among high-mortality states, GDP per capita correlated strongly with lower mortality (r = -0.76; p = 0.018) (Figure-2). Cardiology fellowship programs per state were inversely associated with mortality but did not reach significance (r = -0.24; p = 0.09) (Figure-3).
Conclusion: Female arrhythmia-related mortality exhibits substantial geographic disparities, inversely associated with state-level economic capacity and hospital density. Although the correlation with cardiology training programs did not reach statistical significance, the observed inverse trend may reflect the broader impact of specialist workforce distribution on access to cardiovascular expertise and longitudinal care. These findings underscore the need for strategic investment in healthcare infrastructure and specialist training programs-particularly in high-burden regions-to help reduce preventable arrhythmia-related deaths among women.