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

Researchers from Emory University’s Rollins School of Public Health are participating in a landmark 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 four southern states—Kentucky, Alabama, Mississippi and Louisiana. It will offer clues on how to alleviate these diseases, including factors that amplify risk and resilience in rural communities.

The six-year, $21.4 million study will recruit 4,000 multi-ethnic participants from 10 of the most economically disadvantaged rural counties in southern Appalachia and the Mississippi Delta. It includes 50 investigators from 16 institutions across the country, and is funded by the National Heart, Lung, and Blood Institute, which is part of the National Institutes of Health.

A transdisciplinary team will use a mobile examination unit—essentially, "a research center on wheels"—to conduct an approximately four-hour-long detailed baseline examination on study participants. Familial, lifestyle, environmental, economic and behavioral factors will be recorded along with medical history including risk for HLBS disorders. Researchers will use smartphones and wearable activity monitors to gather data about the health and lifestyles of participants.

Three Rollins faculty members, Viola Vaccarino, MD, PhD; Tené Lewis, PhD; and Gene Brody, PhD; will work with colleagues from the University of California, Berkeley, on the social determinants portion of the study. “We will develop, implement and evaluate psychosocial instruments and methods that are best suited for this special population, and provide training and troubleshooting for research staff involved in behavioral and psychosocial assessments,” Vaccarino says.

Rural populations, according to Lewis, have typically been understudied despite having much higher rates of cardiovascular and lung diseases. “We recognize that the causes of rural-urban health disparities are likely multifactorial, but we believe that psychological and social factors play a key role,” she says. “We are well positioned to improve our understanding of factors that may drive some of the increased rates of disease that we are seeing in these communities.”

Apart from Emory, the other institutions participating in RURAL are Duke University; Johns Hopkins University; Los Angeles BioMedical Research Institute; 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.

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 study coordinating center is Boston University School of Medicine.