New study asks why people in the rural South suffer poorer health and die sooner

May 22, 2019

Dr. Robert Agans

Robert Agans, PhD, associate professor in the Department of Biostatistics at the UNC Gillings School of Global Public Health, is helping lead a new six-year, $21.4 million 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) focuses on uncovering the causes behind the high burden of heart, lung, blood and sleep (HLBS) disorders in select rural areas in the Southeastern United States and how they might be alleviated.

To better understand why certain factors amplify risk in some rural counties and what renders some communities more resilient, researchers will recruit and study 4,000 participants representing multiple ethnic groups from 10 of the most economically disadvantaged rural counties in the southern Appalachia and Mississippi delta region.

“We aim to understand the health ‘penalty’ experienced by people living in rural areas in this region,” said Agans. “Our hypothesis is that individual differences arise from a complex interaction of exposures that span many domains, including adverse environmental factors and exposures, psychosocial factors, and behavioral and lifestyle choices. Genes, poverty, gender and minority status may exacerbate the influence of these factors on HLBS risk, whereas individual and group-level resilience factors may buffer it.”

UNC will serve as the Sampling and Survey Methods Core for the RURAL project. In this role, UNC researchers will design a probability-based method for sampling the targeted region. Their task is to guide how the project should acquire a sample of eligible 25-64 year old residents in 10 counties in four U.S. states — Kentucky, Alabama, Mississippi and Louisiana — with sufficient representation from minority populations, including those of Hispanic and African-American race/ethnicity.

Along with Agans, UNC collaborators include William Kalsbeek, PhD, Professor Emeritus in the Department of Biostatistics, and Franklyn Gonzalez, a biostatistician in the Collaborative Studies Coordinating Center. With funding from the National Heart, Lung and Blood Institute, the multi-site longitudinal cohort study will include, in total, 50 investigators from 15 institutions.

Using a self-contained mobile examination unit — ‘a research center on wheels’ — an interdisciplinary team will conduct an approximately four-hour detailed baseline examination on all study participants. researchers will record familial, lifestyle and behavioral factors, along with medical history (including risk for HLBS disorders). Environmental and economic factors also will be studied, and standard and novel risk factors for HLBS disorders will be assayed. The investigators will use smart phones and wearable activity monitors in order to help collect health and lifestyle information from 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, principal investigator for RURAL 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 rural communities.”

In addition, investigators from the University of Louisville, Kentucky; Louisiana State University’s Pennington Biomedical Research Center; the University of Mississippi Medical Center; and the 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.

Other 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; 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.

Contact the Gillings School of Global Public Health communications team at sphcomm@listserv.unc.edu.