RURAL: Risk Underlying Rural Areas Longitudinal Cohort Study

摘要 生活在南方贫困农村社区的人比生活在农村社区的人寿命更短，健康状况更差。 在美国的其他地方。这种农村负担非常高的基础是心、肺和血液疾病 不放过任何种族的HLBS，目前还不清楚。然而，在同一个南部地区， 疾病风险极低的县，其贫困、种族/民族和农村特征与高风险县相似 风险之一。因此，我们不知道哪些因素放大了南方农村的风险， 一些社区具有复原力，但另一些社区则更加脆弱。为了研究这个问题，我们将招募一名农村（风险） 基础农村地区纵向研究）4000名参与者（年龄35-64岁，50%为女性; 44%为 白人，45%黑人，10%西班牙裔）来自南部四个州（肯塔基州， 亚拉巴马、密西西比和路易斯安那）。我们将针对6个风险较高和4个风险较低的农村县， 在“国内”，他们的贫困程度，种族/民族组成，和他们的总人口规模。 我们将使用一台设备齐全的移动的检查设备（配备CT扫描仪和数字技术）， 检查：描述当地建筑，社会和经济环境;评估家庭，生活方式因素， 和病史;测定标准和新的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分钟步行和口腔刺激的生理反应。 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健康工具在农村环境中的效用 活动监测器;建立生物和数据存储库，并为当前和未来建立强大的社区协作 问题研究对参与者的监测将有助于我们识别和裁定/验证新的HLBS疾病事件。 我们的中心假设是，生活在这10个高风险和低风险人群中的HLBS风险差异 南方农村县是由不同暴露之间的协同作用产生的。不利的麻烦 造成身体更大的“磨损”，影响心理健康，并影响生活方式的选择， 影响HLBS风险。遗传易感性的增加、贫困的加剧和少数民族的地位都加剧了风险。 我们将测试这个假设与以下目标：目标1。全面描述麻烦的特征， 个体和农村参与者的社区水平，并将其与生物功能和HLBS风险相关 跨部门;研究这些协会如何可能被修改的年龄，性别，种族/民族，和居住在 高风险与低风险的县。目标二。前瞻性地将疾病与HLBS疾病的发病率联系起来， 根据年龄、性别、种族/民族和居住在高风险与低风险AMD县来评估效应改变。我们 我们将分析收集到的数据，公布我们的结果，并与这些农村社区分享主要发现。 RURAL将告诉我们是什么导致了南部农村的HLBS疾病负担，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.