Understanding the Macrosocial Drivers of Cardiovascular Health in the Rural South

Project Summary Rural Americans currently face a significant health crisis marked by a heightened prevalence of cardiovascular disease (CVD), the leading cause of mortality in the United States, responsible for one-third of all deaths and claiming a life every 34 seconds. Although this rural health crisis affects all races and ethnicities, studies suggest

that racial disparities are more pronounced than those seen in urban settings. Therefore, there is a critical need to comprehend the key drivers behind these health inequities. Limited understanding exists regarding the multi- level determinants of the elevated burden of poor cardiovascular health in rural areas. Neighborhood

environments, in particular, may serve as critical drivers of CVD inequities in rural areas. Previous research highlighting the significance of neighborhood environments in driving CVD risk and racial/ethnic disparities in CVD was conducted in predominately urban areas, leaving approximately 20% of the population understudied.

Furthermore, neighborhoods serve as more than just places of residence. They represent environments that shape intricate interactions between individuals and historically contingent settings, influencing access to the social determinants of health associated with CVD risk. Investigating the impact of distinct structural processes of

disinvestment in rural areas, particularly in the southern United States, and their influence on neighborhood opportunity and vulnerability, with a focus on the racialized nature of these processes potentially leading to CVD health inequities, is crucial. To address these gaps in knowledge, this proposal seeks to examine the

neighborhood-level drivers of persistently poor cardiovascular health outcomes and disparities in the Southeastern region of the United States. It focuses on neighborhood measures of social vulnerability and disinvestment, representing the adverse impacts of neighborhoods on natural disasters and the disproportionate

disruption of livelihoods. The proposal also addresses neighborhood racial and economic isolation, emphasizing the critical role of residential segregation. Phase 1 of the proposal will examine the geospatial variation in disinvestment, social vulnerability, and racial and socioeconomic isolation across 4,108 census tracts in four

states (AL, MS, LA, and KY) and differences by rurality. Phase 2 will leverage data from the Risk Underlying Rural Areas Longitudinal Study (RURAL; U01 HL146382), which will recruit 4,600 individuals aged 25-64 from 10 rural counties in Appalachia and the Mississippi Delta of the US to explore associations between these measures

and CVD risk factors and whether associations are modified by race and socioeconomic position. All in all, this F31 fellowship will bring together a strong interdisciplinary mentorship team and a rich academic environment at UC Berkeley School of Public Health to support the applicant in achieving the long-term career goals of

becoming an independent health equity scholar working at the intersection of research and public health practice to investigate and address the macrosocial drivers of racial/ethnic health inequities. Successful completion of the study aims will aid in identifying the macrosocial drivers of CVD risk in rural areas.