Abstract 032: Examination of Cardiovascular Risk Factors and Rurality in Appalachian Children using Surveillance, Clustered Statistical Design and Geographic Information Systems (GIS) capabilities.

Abstract

Recent evidence suggests a strong link between rurality and obesity. Our hypothesis for this study is that children living in more rural areas will have higher percentages of body mass index (BMI) above the median; higher levels of total cholesterol (TC), triglycerides (TRIG) and low-density lipoprotein cholesterol (LDL); lower levels of high-density lipoprotein cholesterol (HDL); and higher systolic (SBP) and diastolic blood pressure (DBP) levels after controlling for individual covariates. Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) data was used; 65,531 5 th grade children with home zip codes. Our statistical approach uses a clustered ANCOVA nesting individual children’s fasting lipid profile, BMI and BP results within their home zip coded using the Rural-Urban Continuum Code (RUCC) and controlling for child age, gender, race, and parent education. RUCC, a 9-point classification system, was reduced to 5 categories for this analysis (Figure 1). Significant nested effects were seen for all variables after controlling for covariates, including BMI, HDL, SBP, DBP, TRIG, LDL, and TC (p < 0.001). However, post-hoc comparisons disputed our hypothesis that rural areas would have significantly higher risk factors than urban or metro areas. In particular, Mid-sized metro areas had significantly higher BMI percent above ideal than Large or Small metro areas [21.45 v. 16.57 (p=0.035) and 16.65 (p=0.008)]; no differences between Rural or Urban areas. Large metro and Rural had significantly higher HDLs than Small metro, Urban, and Mid-sized metro areas. Mid-sized metro areas had higher SBP and LDL than Rural or Small Metro areas. This data directly contradicts previous literature suggesting a straight-forward link between rurality and cardiovascular risk factors. In general, Mid-sized metro areas presented the worst outcomes. Future research should include longitudinal design and mechanisms between cardiovascular risk factors and rurality, which could not be addressed in this study.