RURAL: Risk Underlying Rural Areas Longitudinal Cohort Study

联系PD/PI：Ramachandran，Vasan S 摘要 农村摘要(按资助额计算) 生活在南方贫困农村社区的人比住在那里的人活得更短、更不健康 在美国的其他地方。农村心肺和血液疾病(HLBS)负担非常高， 谁不会放过任何种族，目前还不清楚。然而，在同一个南方地区，有一些县 疾病风险非常低，具有与高风险人群相似的贫困、种族/民族和乡村特征。 因此，我们不了解哪些因素放大了南方农村的风险，以及是什么导致了一些 社区有韧性，但其他社区更脆弱。为了研究这个问题，我们将招募一个农村(风险) 基础农村地区纵向研究)4,000名参与者(年龄35岁-，50%为女性；44% 白人，45%的黑人，10%的西班牙裔)来自南方四个州(肯塔基州， 阿拉巴马州[AL]、密西西比州[密西西比州]和路易斯安那州[洛杉矶])。瞄准6个风险较高、4个风险较低的农村县 根据贫困程度、种族/族裔构成和总人口规模“在国家内部配对”。 我们会使用一套独立的流动检查装置(连同CT扫描仪和数码技术)，进行 检查：确定当地建筑、社会和经济环境的特征；评估家庭、生活方式因素， 和病史；检测标准和新的HLBS危险因素，包括遗传风险；评估肺功能； 测量亚临床疾病负担(冠状动脉钙化和肺部疾病的CT扫描；踝臂指数；脉搏 波速)；测试对体位变化和口服葡萄糖负荷的生理反应；评估 农村环境中的移动健康工具，带有带回家的智能手机和可穿戴的活动监测器；构建生物和数据- 存储库，以及针对当前和未来研究的强大社区协作，以及能力建设 解决社区卫生问题。对参与者的监控将帮助我们识别和裁决/验证新的HLBS 疾病事件。 我们的中心假设是，生活在这10个高风险和低风险农村地区的人之间的HLBS风险差异 南方县是不同风险暴露之间协同作用的结果。不利的曝光会造成 身体更大的“磨损”，影响心理社会健康，影响影响生活方式的选择 HLBS风险。遗传易感性的增加、更大的贫困和少数民族地位都会加剧风险。 我们将通过以下目标来检验这一假设：目标1.全面描述曝光体的特征 在农村参与者中的个人和社区水平，并将其与生物功能和HLBS风险联系起来 研究这些关联如何因年龄、性别、种族/民族和居住地而改变 高风险县与低风险县。目的2.前瞻性地将暴露组与HLBS病的发病率联系起来，以及 根据年龄、性别、种族/民族和居住地在高风险与低风险AMD县评估效果调整。我们会 分析收集的数据并发布我们的结果，并与这些农村社区分享主要发现。 农村将告诉我们是什么造成了南方农村地区的HLBS疾病的负担，以及如何减轻它。 项目摘要/摘要

Contact PD/PI: Ramachandran, Vasan S Abstract RURAL Abstract (as funded) People living in poor rural communities in the South live shorter and less healthy lives than those residing elsewhere in the United States. The basis of this very high rural burden of heart, lung and blood diseases (HLBS), which does not spare any race, is unclear. Within the same Southern regions, however, there are counties with very low risk of disease that have profiles of poverty, race/ethnicity, and rurality similar to the high risk ones. Therefore, we do not understand which factors amplify risk in the rural South, and what renders some communities resilient but others more vulnerable. To study this problem, we will recruit a RURAL (Risk Underlying Rural Areas Longitudinal Study) cohort of 4,000 participants (age 35-64 years, 50% women; 44% whites, 45% blacks, 10% Hispanic) from ten of the poorest rural counties in four Southern states (Kentucky [KY], Alabama [AL], Mississippi [MS] and Louisiana [LA]). We will target six higher risk and four lower risk rural counties `paired within state' for their degree of poverty, race/ethnic composition, and their total population sizes. Using a self-contained mobile examination unit (with a CT scanner and digital technology), we will conduct an examination to: characterize the local built, social and economic environments; assess familial, lifestyle factors, and medical history; assay standard and novel HLBS risk factors, including genetic risk; evaluate lung function; measure subclinical disease burden (CT scan for coronary calcium and lung disease; ankle-brachial index; pulse wave velocity); test physiological responses to postural change, and an oral glucose load; appraise the utility of mHealth tools in rural settings with `take-home' smartphones and wearable activity monitors; build bio- and data- repositories, and robust community collaboratives for current and future studies, as well as capacity building to address community health. Surveillance of participants will help us to identify and adjudicate/validate new HLBS disease events. Our central hypothesis is that differences in the HLBS risk among people living in these 10 high- and low-risk rural Southern counties arise from the synergistic interaction among diverse exposures. An adverse exposome creates greater `wear and tear' of the body, affects psychosocial well-being, and impacts lifestyle choices that influence HLBS risk. Increased genetic predisposition, greater poverty, and minority status all exacerbate risk. We will test this hypothesis with the following aims: Aim 1. Characterize the exposome comprehensively at the individual and at the community-level in RURAL participants, and relate it to biological function and HLBS risk cross-sectionally; study how these associations may be modified by age, sex, race/ethnicity, and residence in a high vs. low-risk county. Aim 2. Relate the exposome to the incidence of HLBS disease prospectively, and evaluate effect modification by age, sex, race/ethnicity, and residence in a high vs. low-risk AMD county. We will analyze the collected data and publish our results, and share major findings with these rural communities. RURAL will inform us about what causes the burden of HLBS disease in the rural South and how to alleviate it. Project Summary/Abstract