RURAL: Risk Underlying Rural Areas Longitudinal Cohort Study

摘要 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负担如此之高的基础 (HLBS)不放过任何种族，目前尚不清楚。然而，在相同的南方地区，有 疾病风险非常低的县，其贫困、种族/民族和乡村状况类似于 有风险的人。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，但另一些社区更脆弱。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、密西西比州和路易斯安那州)。我们将以6个高风险和4个低风险农村县为目标 根据其贫困程度、种族/族裔构成和总人口规模，在国家“范围内”。 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； 脉搏波速度)；测试对姿势变化、握手、6分钟步行和口腔运动的生理反应 血糖负荷；评估mHealth工具在农村环境中的效用，包括带回家的智能手机和可穿戴设备 活动监控；构建生物和数据存储库，以及针对当前和未来的强大社区协作 学习。对参与者的监测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个高风险和低风险人群中的HLBS风险的差异 南方农村县的产生源于不同风险敞口之间的协同作用。不利的曝光 对身体造成更大的“磨损”，影响心理社会健康，影响生活方式的选择 影响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 横截面；研究这些关联如何根据年龄、性别、种族/民族和居住地进行修改 高风险VS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 将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。

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.