Why are those born in the rural South less healthy and prone to die sooner?

Researchers from the Los Angeles Biomedical Research Institute (LA BioMed) are participating in a novel study to understand why people born in rural communities in the South live shorter and less healthy lives than their counterparts elsewhere in the country. 

The Risk Underlying Rural Areas Longitudinal Study (RURAL) will allow researchers to learn what causes the burden of heart, lung, blood and sleep (HLBS) disorders in select rural areas in Kentucky, Alabama, Mississippi and Louisiana and offer clues regarding how to alleviate them. 

To better understand why certain factors amplify risk in some rural counties and what renders some communities more resilient, researchers will be recruiting and studying 4,000 multi-ethnic participants from 10 of the most economically disadvantaged rural counties in southern Appalachia and Mississippi Delta and parts of the rural South.

Researchers from LA BioMed who are participating in this study are on the steering committee that designed the study and will be primarily responsible for both cardiovascular testing (heart scans and blood vessel health) and for the genetics components of the study.

“We are excited about being part of the most important cardiovascular study facing our nation today, specifically why there is such a disparity in health in those who live in the rural South,” said Matthew Budoff, MD, who is leading the LA BioMed cardiovascular testing study team. “We hope to find those factors that are causing excess harm and be able to address these risks to improve the health of this population.” “One of the central questions is whether specific genetic susceptibilities, interacting with local environmental factors, are in part responsible for this increased risk,” said Jerome Rotter, M.D., who is leading the LABioMed genomics study team.

With funding from the National Heart, Lung, and Blood Institute, part of the National Institutes of Health, this six-year, $21.4 million multi-site longitudinal cohort study will include 50 investigators from 15 other institutions. 

Using a self-contained mobile examination unit, ‘a research center on wheels,’ a transdisciplinary 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 will also be studied and standard and novel risk factors, including assessment of genomic risks, for HLBS disorders will be assayed. Investigators will use smart phones and wearable activity monitors in order to help collect health and lifestyle information of the participants. 

“The rural health challenge in the South does not spare any race or ethnicity. These high risk and economically disadvantaged communities are vulnerable to clusters of multiple health problems,” explained Vasan Ramachandran, MD, FAHA, FACC, principal investigator and Boston University director of the renowned Framingham Heart Study, with which he has been affiliated for more than 20 years. “We aim to understand the rural health challenge in the South and share our findings with and offer health education to these rural communities.”

In addition, investigators from the University of Louisville (Kentucky), LSU’s Pennington Biomedical Research Center, University of Mississippi Medical Center and University of Alabama at Birmingham, will play a central role in participant recruitment, retention, follow-up, data return, return of results, community engagement and education.

The other 10 institutions participating in RURAL are Duke University; Emory University; Johns Hopkins University; LA BioMed; 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; University of Virginia at Charlottesville and the Wake Forest School of Medicine. 

The study coordinating center is Boston University School of Medicine (BUSM).