Journal of General Internal Medicine

, Volume 34, Issue 6, pp 815–817 | Cite as

Factors Underlying Increased Incidence of Sudden Unexpected Death in Rural Counties in North Carolina

  • Zoe Su Wen Gan
  • Wansuk Choi
  • Feng-Chang Lin
  • Rebecca Tippett
  • Golsa Joodi
  • Irion Pursell
  • Ross Joseph SimpsonJrEmail author
Concise Research Reports


Sudden unexpected death (SUD) is a common syndrome that has not been well-characterized in urban and rural populations. Previous work has found a higher incidence of sudden cardiac death (SCD)1 in rural populations. However, as strict criteria for SCD based on reported cause and timing of death often exclude deaths from non-cardiac causes that have potential epidemiological overlap with SCD, it is important to take an inclusive approach.2 As rural areas are also challenged with shortages of primary care providers, mental health providers, and health insurance,3we hypothesize that the incidence of SUD is higher in rural counties than in urban counties due to discrepancies in these measures of health care access. In this study, we (1) compare the incidence of SUD between rural and urban counties in North Carolina (NC) and (2) determine if specific measures of health care access are independent predictors of SUD. In these ways, this work is a preliminary step towards risk...



Special thanks to Dr. John P. Mounsey for assistance with manuscript review.


The project was supported by the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, through Grant Award Number UL1TR001111; additional funding was provided through grant number T35-DK007386 from the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Zoe Su Wen Gan
    • 1
  • Wansuk Choi
    • 2
  • Feng-Chang Lin
    • 3
  • Rebecca Tippett
    • 4
  • Golsa Joodi
    • 5
  • Irion Pursell
    • 5
  • Ross Joseph SimpsonJr
    • 5
    Email author
  1. 1.University of North Carolina School of MedicineChapel HillUSA
  2. 2.Department of BiostatisticsUniversity of North Carolina at Chapel HillChapel HillUSA
  3. 3.The North Carolina Translational & Clinical Sciences InstituteChapel HillUSA
  4. 4.Carolina Population CenterChapel HillUSA
  5. 5.Department of Medicine, Division of Cardiology, UNC Heart and VascularUniversity of North Carolina at Chapel HillChapel HillUSA

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