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: 10424663
• 负责人: Suzanne E Judd
• 金额: $ 3.29万
• 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 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10424663
• 关键词: Affect; Age; Alabama; Ankle; Appalachian Region; Behavioral; Biological Assay; Biological Process; 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; Hispanics; 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; Personal Satisfaction; 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; pulmonary function; recruit; residence; resilience; response; rural area; rural counties; rural setting; rurality; sex; social; social factors; 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 与居住的人相比，生活在南部贫穷的农村社区的人比居住 在美国其他地方。这种非常高的心脏，肺和血液疾病的乡村负担的基础 （HLB）尚不清楚任何种族。但是，在同一南部地区，有 疾病风险非常低的县具有贫困，种族/种族和乡村的特征 风险。因此，我们不明白哪些因素会扩大南方农村的风险，以及哪些因素渲染 有些社区具有韧性，但有些社区更容易受到伤害。为了研究这个问题，我们将招募农村（风险 潜在的农村地区纵向研究）4000名参与者（35-64岁，女性50％； 44％）的队列 白人，45％的黑人，10％西班牙裔），来自四个南部州（肯塔基州，肯塔基州）的十个县中的十个县 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的风险和四个较低的风险乡村'配对 在州内的贫困程度，种族/族裔组成及其总人口规模。 使用独立的移动检查单元（带有CT扫描仪和数字技术），我们将进行 考试：以当地，社会和经济环境为特征；评估家庭，生活方式因素， 和病史；测定标准和新型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（用于冠状动脉钙和肺部疾病的CT扫描；脚踝 - 马拉科指数； 脉冲波速度）；测试对姿势变化的生理反应，手夹，步行6分钟和口腔 葡萄糖负荷；评估MHealth工具在乡村环境中使用“带入式”智能手机和可穿戴设备的实用性 活动监视；建立生物和数据纠正仪，并为当前和未来建立强大的社区合作 研究。对参与者的监视将帮助我们识别和裁定/验证新的HLB疾病事件。 我们的中心假设是，这10个高风险和低风险的人群中HLB的风险差异 南部县的农村县来自各种暴露之间的协同互动。不利的博览会 创造身体更大的“磨损”，影响社会心理健康，并影响生活方式的选择 影响HLB的风险。增加遗传易感性，更大的贫困和少数群体状况都加剧了风险。 我们将以以下目的检验这一假设：目标1。 个人和在农村参与者的社区级别，并将其与生物功能和HLBS风险联系起来 横截面；研究如何通过年龄，性别，种族/种族和住所来修改这些关联 高风险县高。 AIM 2。前瞻性地将剥出体与HLBS疾病的发病率联系起来，并且 在高风险AMD县的年龄，性别，种族/种族和居住下，评估效果修改。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。 农村将告知我们是什么原因导致南方农村疾病的负担以及如何减轻疾病。