A six-year, $21.4 million study funded by the NIH’s National Heart, Lung, and Blood Institute will study 10 low-income rural counties in Kentucky, Alabama, Mississippi and Louisiana to learn what causes the burden of heart, lung, blood and sleep (HLBS) disorders in these communities and how to alleviate them.
People born in rural communities in the South, especially in southern Appalachia and the Mississippi Delta, may live shorter and less healthy lives than their counterparts elsewhere in the country, in part due to a high burden of HLBS disorders. Within the same Southern regions, however, there are counties with very low risk of disease that have profiles of economic disadvantages, race/ethnicity, and rurality similar to those considered high risk. In an effort to understand why certain factors amplify risk in some rural counties and what renders some communities more resilient, the Risk Underlying Rural Areas Longitudinal (RURAL) Study will allow researchers to study 4,000 multi-ethnic participants from these regions. Enrollment is scheduled to begin in Alabama, in the summer of 2020.
Broad goals of the RURAL Cohort Study include:
• Identifying the distribution and determinants of heart and lung diseases in the RURAL communities;
• Identifying unique factors contributing to health disorders in these communities — including psychosocial, economic, and familial factors — and how they interact together; and
• Identifying potential solutions by examining differences between higher and lower risk rural counties.
Using a self-contained mobile examination unit, a cross-disciplinary team will conduct an approximately four-hour detailed baseline examination on the study participants. Familial, lifestyle and behavioral factors, along with medical history including risk for HLBS disorders will be recorded. Environmental and economic factors also will be studied and standard and novel risk factors for HLBS disorders will be assayed. Investigators will use smartphones and wearable activity monitors in order to help collect health and lifestyle information of the participants.
This multi-site prospective cohort study will be coordinated by Boston University School of Medicine's Vasan Ramachandran, M.D., principal investigator and Boston University director of the renowned Framingham Heart Study, with which he has been affiliated for more than 20 years.
"The rural health challenge in the South does not spare any race or ethnicity. These high risk and economically disadvantaged rural communities are vulnerable to clusters of multiple health problems," said Ramachandran, in a prepared statement. "We aim to understand the rural health challenges in the South and share our findings with and offer health education to these rural communities."
Over 50 investigators at 16 institutions will participate in the study.
A Social Determinants Core represents a multi-institutional collaboration between the School of Public Health at University of California, Berkeley, and the Rollins School of Public Health at Emory University. It will be responsible for assessing multi-level contextual, psychological, social, environmental determinants of health among RURAL participants.
A Genomics Core will be led by the Institute for Translational Genomics and Population Sciences at Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center (LA BioMed). It will be responsible for the production of large-scale genotype data, quality control, imputation, and statistical genetic analyses on RURAL participants.
Stephanie Boone, Ph.D., M.P.H., University of Louisville (Kentucky); Stephanie Broyles, Ph.D., LSU's Pennington Biomedical Research Center; Ervin Fox, M.D., M.P.H., University of Mississippi Medical Center; Suzanne Judd, Ph.D., University of Alabama at Birmingham and Paul Targonski, M.D., Ph.D., University of Virginia at Charlottesville will play a central role in participant recruitment, retention, follow-up, data collection, return of results, community engagement and education.
The other 10 institutions participating in RURAL are Duke University; Emory University; Johns Hopkins University; Los Angeles BioMedical Research Institute (UCLA); University of California, Berkeley; University of Massachusetts Medical School; University of North Carolina at Chapel Hill; Perelman School of Medicine at the University of Pennsylvania; Larner College of Medicine at the University of Vermont and the Wake Forest School of Medicine.
A story on the UMass Medical School website noted that David McManus, M.D., the Dr. Marcellette G. Williams Distinguished Scholar and associate professor of medicine in the Division of Cardiovascular Medicine, population & quantitative health sciences, is the primary investigator of the mobile health core of the RURAL study. He and Jomol Mathew, Ph.D., assistant professor of population & quantitative health sciences and chief research informatics officer for UMMS, designed a mobile platform to be used in data gathering for the grant. The mobile platform includes a smartphone app and a wearable, wrist-based informatics system. “We are very excited about the science that will flow from this one-of-a-kind project targeting members of rural communities,” McManus is quoted as saying. “We think that mobile health is a key piece of this big and information-rich research study.”
Stephanie Boone, Ph.D., M.P.H., the lead Kentucky researcher and an assistant professor at the University of Louisville School of Public Health and Information Studies, told WFPL News that there’s a need for ongoing public health research in Kentucky, which is consistently ranked as one of the worst for poor health conditions and high mortality rates linked to heart disease.
“The fact that this is an observational study, not a clinical study, and that we are interested in population health and also the health within the communities and making that a priority is important,” Boone told WFPL News.
As the six-year study progresses, Boone said she hopes the research will be used and applied to improve health in the communities.
“We [will] give published results to the community partners where they can help devise a health needs assessment and help to plan at the local level, some things that they need to do and provide for their community,” she said. “Additionally, we want to connect people to resources if they need further diagnostic tests, if they need education, or materials for future evaluation of any type of disease that may be diagnosed.”
