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.

Grant Number: 5F31MD020261-02
NIH Institute/Center: NIH
Principal Investigator: Larissa Benjamin