Study to explore reasons rural communities are less healthy

A new study hopes to help researchers understand what causes high rates of heart, lung, blood and sleep disorders (HLBS) in rural Kentucky, Alabama, Mississippi and Louisiana.

Dubbed the Risk Underlying Rural Areas Longitudinal (RURAL) study, Stephanie Boone, Ph.D., assistant professor, University of Louisville School of Public Health and Information Sciences, will lead the research in Kentucky.

The overall study is coordinated by Boston University School of Medicine and funded by the National Heart, Lung, and Blood Institute, part of the National Institutes of Health. The six-year, $21.4 million multi-site prospective epidemiology cohort study includes 50 investigators from 15 other institutions.

“The burden of health outcomes in rural Kentucky and the other states in this study are a result of poorly understood factors that affect all people,” Boone said. “Understanding differences and root causes in vulnerable communities where people live and age is relevant and timely in the Commonwealth, especially given the ongoing health care system transformation.”

The number of heart disease-related deaths in 2017 placed Kentucky 9th among all states and territories in the United States. Some rural counties, particularly in the Appalachian region, experience higher rates of heart disease, chronic obstructive lung disease (COPD), and stroke mortality rates. These same areas also report a higher prevalence of risk factors for poor health including unhealthy lifestyles, low-income and exposure to unique environmental hazards compared to non-Appalachian regions in Kentucky.

To better understand why certain factors amplify risk in some rural counties while other communities appear to be more resilient, the researchers will recruit 4,000 multi-ethnic participants from 10 rural counties in the Southern Appalachia and Mississippi Delta (AMD) regions.

In Kentucky, Boone and her team, including co-investigators Kathy Baumgartner, Ph.D., and Rick Baumgartner, Ph.D., will play a central role in community engagement and recruitment of approximately 1,300 men and women for retention and surveillance over a six-year period.

The research teams will use a mobile examination unit to conduct a baseline exam with each participant. They will record information about family history, lifestyle and behavioral factors, along with medical history including risk for HLBS disorders. Environmental and economic elements also will be evaluated. Smart phones and wearable activity monitors will be used to help collect health and lifestyle information from the participants.

“We aim to understand the rural health penalty in the AMD and share our findings with and offer health education to these rural communities,” said Vasan Ramachandran, M.D., F.A.H.A., F.A.C.C., principal investigator and Boston University director of the Framingham Heart Study.

In addition to UofL, LSU’s Pennington Biomedical Research Center, University of Mississippi Medical Center and University of Alabama at Birmingham represent the core states in which participants will be recruited.

Other institutions participating in RURAL are Duke University, Emory University, Johns Hopkins University, Los Angeles BioMedical Research Institute (UCLA), University of California, Berkeley, University of Massachusetts, University of North Carolina at Chapel Hill, University of Pennsylvania, University of Vermont, University of Virginia at Charlottesville and the Wake Forest School of Medicine.

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