Wednesday, April 24, 2024
4/24/2024
Project Summary The higher burden of cardiovascular disease (CVD) in rural areas, particularly in Appalachia and the Mississippi Delta is alarming, yet virtually nothing is known about the underlying factors contributing to this rural health penalty. Prior research has shown that neighborhood environments are important drivers of CVD risk and racial/ethnic disparities in CVD; however, this work has been conducted almost exclusively in urban cohorts, leaving ~20% of the population understudied in regard to the #1 cause of mortality in the US. It remains unknown whether traditional features of neighborhood environments (e.g., food access, crime, social cohesion) operate similarly in rural areas to impact CVD risk, and this must be investigated rigorously. There is also an urgent need to better understand the role of more unique features of rural communities, such as geo- spatial isolation of residences, distance between businesses and retail outlets, and social networks operating in these contexts. It is important to characterize these unique rural neighborhood typologies and to investigate which subgroups may be most vulnerable to the cardiovascular health impacts of different neighborhood archetypes. We will examine whether associations are more deleterious among those who are psychosocially vulnerable – those with high levels of childhood trauma or inadequate social support. Finally, factors that contribute to cardiovascular resilience have also been understudied and we have a unique opportunity to investigate the multi-level factors that may contribute to CVD resilience (optimism, purpose in life, resilient coping). Thus, the overarching goal of the proposed study is to: 1) examine the relationship between neighborhood factors and unique neighborhood typologies on cardiovascular health (CVH) in rural communities, 2) determine which groups are most psychosocially vulnerable, and 3) determine whether the impact of adverse neighborhood typologies on CVH and subclinical CVD is mitigated by psychological resilience. The final, exploratory goal of this study is to 4) assess if associations are modified by age, sex, or race/ethnicity. To achieve these goals, we will leverage existing data from the Risk Underlying Rural Areas Longitudinal Study (RURAL) that will recruit 4,600 individuals ages 25-64 from 10 rural counties in Appalachia and the Mississippi Delta of the United States. We will augment this rich rural cohort by linking new data sources (e.g., geo-spatially referenced databases) and creating new measures in order to provide a comprehensive database of indicators of neighborhood physical and social environments. All in all, this work may help provide a more nuanced understanding of the multi- level determinants of both CVD risk and resilience and may help to identify novel levers of intervention to improve cardiovascular health in rural communities.
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