RURAL: Risk Underlying Rural Areas Longitudinal Cohort Study

农村：农村地区潜在风险纵向队列研究

• 批准号: 10428521
• 负责人: Suzanne E Judd
• 金额: $ 293.54万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-15 至 2022-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10428521
• 关键词: Affect; Age; Alabama; Ankle; Appalachian Region; Behavioral; Biological Assay; Biological Process; Black Populations; Buffers; Cellular Phone; Clinic; Clinical; Cohort Studies; Communities; Community Health; Complex; County; Cross-Sectional Studies; Data; Diabetes Mellitus; Disease; Economic Factors; Economics; Environment; Environmental Risk Factor; Epidemic; Ethnic Origin; Ethnic group; Etiology; Event; Frequencies; Future; Generations; Genetic Predisposition to Disease; Genetic Risk; Glucose; Health; Health Personnel; Health education; Heart Diseases; Heart Rate; Hematological Disease; Hispanic; Home; Hot Spot; Hour; Hypertension; Image; Incidence; Individual; Kentucky; Kidney Diseases; Knowledge; Learning; Life Style; Longitudinal Studies; Longitudinal cohort study; Louisiana; Lung; Lung diseases; Malignant Neoplasms; Measures; Mediation; Medical History; Medical Records; Minority; Mississippi; Modernization; Modification; Monitor; Morbidity - disease rate; Neighborhoods; Obesity; Oral; Participant; Patient Recruitments; Patient Self-Report; Pattern; Persons; Physiologic pulse; Physiological; Population Sizes; Postural adjustments; Poverty; Prevalence; Prognosis; Psychosocial Factor; Public Health; Publishing; Race; Risk; Risk Factors; Rural; Rural Appalachia; Rural Community; Rural Health; Sampling; Scientist; Sleep Disorders; Spirometry; Spottings; Technology; Testing; Time; Translating; United States; Variant; Walking; Woman; X-Ray Computed Tomography; adjudicate; allostatic load; biobank; burden of illness; cardiogenesis; cohort; coronary artery calcium; data harmonization; data repository; digital; disorder risk; early onset; experience; health disparity populations; high risk; implementation science; improved; indexing; innovation; lifestyle factors; mHealth; male; men; middle age; mortality; multi-ethnic; novel; polygenic risk score; premature; prevent; prospective; psychosocial wellbeing; pulmonary function; recruit; residence; resilience; response; rural area; rural counties; rural setting; rurality; sex; social; social factors; syndemic; tool; trait; urban area

Abstract 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 4000 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, Alabama, Mississippi and Louisiana). 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, handgrip, a 6-minute walk, 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. 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.

抽象的 生活在南方贫困农村社区的人们比居住在该地区的人们寿命更短，健康状况也更差 在美国其他地方。农村地区心、肺和血液疾病负担非常高的基础 （HLBS）不放过任何种族，目前尚不清楚。然而，在同一南部地区， 疾病风险极低的县，其贫困、种族/族裔和农村特征与高风险县相似 风险的。因此，我们不明白哪些因素会放大南方农村地区的风险，以及是什么导致了 一些社区具有复原力，但另一些社区则更脆弱。为了研究这个问题，我们将招募一名 RURAL（风险 基础农村地区纵向研究）由 4000 名参与者组成的队列（年龄 35-64 岁，50% 为女性；44% 白人、45% 黑人、10% 西班牙裔）来自南部四个州（肯塔基州、肯塔基州、 阿拉巴马州、密西西比州和路易斯安那州）。我们将针对六个较高风险和四个较低风险的农村县进行“配对” 州内的贫困程度、种族/族裔构成及其总人口规模。 使用独立的移动检查装置（配有 CT 扫描仪和数字技术），我们将进行 检查目的：描述当地建筑、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 风险因素，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； 脉搏波速度）；测试对姿势变化、握力、6 分钟步行和口腔的生理反应 葡萄糖负荷；通过“带回家”的智能手机和可穿戴设备评估移动医疗工具在农村环境中的效用 活动监视器；为当前和未来建立生物和数据存储库以及强大的社区协作 研究。对参与者的监测将帮助我们识别和裁定/验证新的 HLBS 疾病事件。 我们的中心假设是，生活在这 10 个高风险和低风险地区的人们的 HLBS 风险存在差异 南方农村县是由不同风险之间的协同相互作用而产生的。不良暴露组 造成身体更大的“磨损”，影响社会心理健康，并影响生活方式的选择 影响 HLBS 风险。遗传倾向的增加、贫困的加剧和少数族裔地位都会加剧风险。 我们将通过以下目标来检验这一假设： 目标 1. 全面表征暴露组 农村参与者的个人和社区层面，并将其与生物功能和 HLBS 风险联系起来 横截面；研究这些关联如何因年龄、性别、种族/族裔和居住地而改变 高风险县与低风险县。目标 2. 前瞻性地将暴露组与 HLBS 疾病的发病率联系起来，以及 根据年龄、性别、种族/族裔以及居住在高风险 AMD 县与低风险 AMD 县的情况来评估效果修正。我们 我们将分析收集到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。 RURAL 将告诉我们导致南方农村地区 HLBS 疾病负担的原因以及如何减轻这种负担。