Neighborhoods and Cardiovascular Risk and Resilience in Rural Communities

项目摘要 农村地区心血管疾病负担较重，特别是在阿巴拉契亚和 密西西比河三角洲令人担忧，但对造成这一现象的潜在因素几乎一无所知 农村卫生处罚。先前的研究表明，邻里环境是心血管疾病的重要驱动因素 心血管疾病的风险和种族/民族差异；然而，这项工作几乎只在城市地区进行。 队列，留下约20%的人口关于美国头号死亡原因的研究不足。它 尚不清楚邻里环境的传统特征(例如，食物获取、犯罪、社会 凝聚力)在农村地区以类似方式运作，影响心血管疾病风险，必须对此进行严格调查。的确有 此外，迫切需要更好地了解农村社区的更多独特特征的作用，如地理特征 住宅的空间隔离、企业和零售店之间的距离以及运营的社交网络 在这些情况下。重要的是要描述这些独特的农村社区类型并进行调查 哪些亚群最容易受到不同社区对心血管健康的影响 原型。我们将研究在那些有心理障碍的人中，联想是否更有害 弱势群体--那些童年创伤程度高或社会支持不足的人。最后，这些因素 对心血管弹性的贡献也没有得到充分的研究，我们有一个独特的机会 调查可能有助于心血管疾病复原力的多层次因素(乐观、生活目标、复原力 应对)。因此，拟议研究的总体目标是：1)检查 邻里因素和独特的邻里类型对农村心血管健康的影响 社区，2)确定哪些群体最容易受到心理伤害，以及3)确定 不良邻域类型对CVH和亚临床CVD的影响可通过心理干预缓解 恢复力。这项研究的最终探索性目标是评估关联性是否因年龄、性别或 种族/民族。为了实现这些目标，我们将利用农村地区潜在风险的现有数据 纵向研究(农村)，将从阿巴拉契亚地区的10个农村县招募4,600名25岁的人- 以及美国的密西西比三角洲。我们将通过链接新数据来扩大这一富裕的农村队列 资源(例如，地理空间参照数据库)和创建新的措施，以便提供 邻里自然和社会环境指标综合数据库。总而言之，这部作品 有助于更细致地理解心血管疾病风险的多层次决定因素和 恢复力，并可能有助于确定新的干预手段，以改善农村心血管健康 社区。

Project Summary The higher burden of cardiovascular disease (CVD) in rural areas, particularly in Appalachia and the Mississippi Delta is alarming, yet virtually nothing is known about the underlying factors contributing to this rural health penalty. Prior research has shown that neighborhood environments are important drivers of CVD risk and racial/ethnic disparities in CVD; however, this work has been conducted almost exclusively in urban cohorts, leaving ~20% of the population understudied in regard to the #1 cause of mortality in the US. It remains unknown whether traditional features of neighborhood environments (e.g., food access, crime, social cohesion) operate similarly in rural areas to impact CVD risk, and this must be investigated rigorously. There is also an urgent need to better understand the role of more unique features of rural communities, such as geo- spatial isolation of residences, distance between businesses and retail outlets, and social networks operating in these contexts. It is important to characterize these unique rural neighborhood typologies and to investigate which subgroups may be most vulnerable to the cardiovascular health impacts of different neighborhood archetypes. We will examine whether associations are more deleterious among those who are psychosocially vulnerable – those with high levels of childhood trauma or inadequate social support. Finally, factors that contribute to cardiovascular resilience have also been understudied and we have a unique opportunity to investigate the multi-level factors that may contribute to CVD resilience (optimism, purpose in life, resilient coping). Thus, the overarching goal of the proposed study is to: 1) examine the relationship between neighborhood factors and unique neighborhood typologies on cardiovascular health (CVH) in rural communities, 2) determine which groups are most psychosocially vulnerable, and 3) determine whether the impact of adverse neighborhood typologies on CVH and subclinical CVD is mitigated by psychological resilience. The final, exploratory goal of this study is to 4) assess if associations are modified by age, sex, or race/ethnicity. To achieve these goals, we will leverage existing data from the Risk Underlying Rural Areas Longitudinal Study (RURAL) that will recruit 4,600 individuals ages 25-64 from 10 rural counties in Appalachia and the Mississippi Delta of the United States. We will augment this rich rural cohort by linking new data sources (e.g., geo-spatially referenced databases) and creating new measures in order to provide a comprehensive database of indicators of neighborhood physical and social environments. All in all, this work may help provide a more nuanced understanding of the multi- level determinants of both CVD risk and resilience and may help to identify novel levers of intervention to improve cardiovascular health in rural communities.