# RURAL: Risk Underlying Rural Areas Longitudinal Cohort Study

> **NIH NIH U01** · BOSTON UNIVERSITY MEDICAL CAMPUS · 2020 · $149,966

## Abstract

Contact PD/PI: Ramachandran, Vasan S
Abstract
RURAL Abstract (as funded)
People living in poor rural communities in the South live shorter and less healthy lives than those residing
elsewhere in the United States. The basis of this very high rural burden of heart, lung and blood diseases (HLBS),
which does not spare any race, is unclear. Within the same Southern regions, however, there are counties with
very low risk of disease that have profiles of poverty, race/ethnicity, and rurality similar to the high risk ones.
Therefore, we do not understand which factors amplify risk in the rural South, and what renders some
communities resilient but others more vulnerable. To study this problem, we will recruit a RURAL (Risk
Underlying Rural Areas Longitudinal Study) cohort of 4,000 participants (age 35-64 years, 50% women; 44%
whites, 45% blacks, 10% Hispanic) from ten of the poorest rural counties in four Southern states (Kentucky [KY],
Alabama [AL], Mississippi [MS] and Louisiana [LA]). We will target six higher risk and four lower risk rural counties
`paired within state' for their degree of poverty, race/ethnic composition, and their total population sizes.
Using a self-contained mobile examination unit (with a CT scanner and digital technology), we will conduct an
examination to: characterize the local built, social and economic environments; assess familial, lifestyle factors,
and medical history; assay standard and novel HLBS risk factors, including genetic risk; evaluate lung function;
measure subclinical disease burden (CT scan for coronary calcium and lung disease; ankle-brachial index; pulse
wave velocity); test physiological responses to postural change, and an oral glucose load; appraise the utility of
mHealth tools in rural settings with `take-home' smartphones and wearable activity monitors; build bio- and data-
repositories, and robust community collaboratives for current and future studies, as well as capacity building to
address community health. Surveillance of participants will help us to identify and adjudicate/validate new HLBS
disease events.
Our central hypothesis is that differences in the HLBS risk among people living in these 10 high- and low-risk rural
Southern counties arise from the synergistic interaction among diverse exposures. An adverse exposome creates
greater `wear and tear' of the body, affects psychosocial well-being, and impacts lifestyle choices that influence
HLBS risk. Increased genetic predisposition, greater poverty, and minority status all exacerbate risk.
We will test this hypothesis with the following aims: Aim 1. Characterize the exposome comprehensively at the
individual and at the community-level in RURAL participants, and relate it to biological function and HLBS risk
cross-sectionally; study how these associations may be modified by age, sex, race/ethnicity, and residence in a
high vs. low-risk county. Aim 2. Relate the exposome to the incidence of HLBS disease prospectively, and
evaluate effect modif...

## Key facts

- **NIH application ID:** 10158701
- **Project number:** 3U01HL146382-02S1
- **Recipient organization:** BOSTON UNIVERSITY MEDICAL CAMPUS
- **Principal Investigator:** Suzanne E Judd
- **Activity code:** U01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $149,966
- **Award type:** 3
- **Project period:** 2020-07-24 → 2025-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10158701

## Citation

> US National Institutes of Health, RePORTER application 10158701, RURAL: Risk Underlying Rural Areas Longitudinal Cohort Study (3U01HL146382-02S1). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10158701. Licensed CC0.

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