exterior of Rural Heart and Lung Study's mobile exam unit

A High-tech Research Clinic on Wheels

NHLBI study assesses health of residents in rural South for heart, lung disease

Adults in the rural South region, which includes Appalachia and the Mississippi Delta, have some of the highest rates of heart disease, obesity, high blood pressure, and chronic obstructive pulmonary disease (COPD) in the country. Heart failure rates, for example, are 19% higher in the rural South than in urban areas, while COPD rates are twice as high. It takes a toll as rural residents tend to live shorter lives, compared with urban residents.

No one knows exactly why the disease rates are so high, but researchers supported by the NHLBI are determined to find out.

Since 2021, they have been conducting the Risk Underlying Rural Areas Longitudinal (RURAL) Cohort Study, a long-term research project aimed at uncovering the roots of these disparities. The researchers hope their findings will lead to actions and policies that help improve the health of the estimated 45 million people living in the region, which includes some of the poorest and most remote areas of the country.

In fact, it can take hours to reach health care in some parts of the region, for example.

To address this problem, the RURAL researchers have come up with a unique solution: They’ve built a state-of-the-art mobile exam unit, or MEU, that will bring to the region badly needed health technologies that make it possible for researchers to get the information they need. The MEU is basically a massive tractor-trailer -- about 52 feet long and weighing 53,000 pounds (26.5 US tons) – with the functionality of an urban primary care office. The custom-made unit houses a high-tech medical imaging room, examination room, laboratory, and waiting room.

David C. Goff, M.D., Ph.D., director of the NHLBI’s Division of Cardiovascular Sciences, said there’s great value in a study like this. “We know a lot about the health of urban populations, but there is a critical gap in research data regarding the health of people in the rural South that needs to be addressed,” he said. “In particular, we’d like to help reduce the region’s high burden of heart and lung diseases, the number one and number six leading causes of death in this country. The RURAL study is an important step toward that goal.”

“This is one of the first epidemiological cohort studies of its kind conducted in the rural South,” said Vasan Ramachandran, M.D., a co-leader of the RURAL Cohort Study and a professor and dean of the School of Public Health at the University of Texas Health Science Center at San Antonio. 

mobile CT scanner
Photo of computerized tomography (CT) scanner housed inside RURAL study’s mobile exam unit. The machine can take detailed images of the heart and lungs to help detect diseases and injuries. Courtesy of the RURAL Study Team, NHLBI

According to Ramachandran, the region’s health decline first became noticeable in the 1980s, and it has steadily worsened. Researchers think they know at least some of what’s contributing to the decline: vast food insecurity, poor access to healthcare, excess weight, and high rates of smoking. But they have had difficulty studying the area in detail – and broadly – due in part to its remoteness and lack of research infrastructure. The vehicle is scheduled to travel through 10 rural counties in Alabama, Kentucky, Louisiana, and Mississippi to conduct a variety of health exams on adult residents ages 25 to 64 who volunteer for the study. Already it’s been to four counties (two in Alabama and two in Mississippi), and about 2,100 participants, roughly half the study’s goal of 4,600 enrollees, have been tested.

Researchers have been looking at routine measures like blood pressure, cholesterol, and blood sugar levels, as well as images of the participants’ heart and lungs. They also have been administering surveys focused on the social determinants of health – the conditions in which people grow up, live, work, and play. Those include questions about education levels, income, neighborhoods, social stresses, and lifestyle, all of which give researchers insights they would never get from health exams alone. 

“So far, we’re seeing striking health challenges, including heart disease at a younger age, as well as high rates of obesity,” said Ramachandran, a former principal investigator for the NHLBI’s Framingham Heart Study, which has followed over 14,000 people since 1948. “Diseases that we saw in participants of the Framingham Heart Study at age 75 are occurring in these rural populations at age 50.” 

While it’s too early to publish comprehensive results from the study, some initial results might be published in early 2024, he said. Data collected by the researchers will be shared with the participants, who will be encouraged to share the information with their healthcare providers. If they do not have a provider, the researchers will refer them to local healthcare professionals. Some health data also will be shared with County officials to help them design improved healthcare policies and programs for the region.

“One of the keys to the success of our project is building up community trust, and we’re doing that by working closely with local community leaders,” Ramachandran said. “The community has welcomed us, and we hope this study will serve as a call to action to improve rural health in the South.”

The study, which is funded through 2025, involves a collaboration with over 50 investigators at 15 institutions nationwide. Researchers hope it will be renewed so they can re-examine the participants during a second visit and see how the diseases have progressed or whether improvements have occurred.