Compared to urban populations, the health of those living in rural communities in the United States has significantly worsened over the past several decades. To help bring forward possible solutions for the disparity in health of rural populations, the American Heart Association (AHA) recently released a Presidential Advisory Call to Action1 to prioritize rural populations in programming, research, and policy. As a next step in addressing this critical issue, the AHA is releasing this Request For Applications (RFA) that propose novel solutions to meaningfully impact rural health disparities.
In the U.S., 15-20% of the population lives in rural counties, as defined by the Office of Management and Budget. While these rural counties are predominantly White (80%), there are significant race and ethnicity differences in parts of the country. For example, the rural South has a large population of non-Hispanic Black individuals, the rural Southwest is home to many Hispanic individuals, and rural Oklahoma, Alaska, the Great Plains, and the Southwest are home to high percentages of American Indian/Alaska Native individuals.2 Rural areas also have a higher percentage of elderly individuals and experience lower population growth and higher rates of poverty compared to urban and suburban populations.
Data going back to 1970 show that through the 1980s, mortality rates for rural and urban populations were comparable. Over the past three decades, however, mortality rates have differentially shifted, such that the mortality rate is now 20% higher in rural populations compared to urban populations.3 Life expectancy has followed a similar pattern, with urban populations living more than three years longer than individuals in rural areas.4 These disparities are especially prominent for indigenous people, whose life expectancy is 5.5 years lower than the general population.5
Cardiovascular conditions are among the disparities in health now present between rural and urban populations. Rural populations have a higher prevalence of heart disease as compared to urban populations, as well as an increased risk for cardiovascular and stroke mortality. The differences in risks have been reported to be 30-40% on average for cardiovascular conditions, and it appears the gap in cardiovascular health outcomes between rural and urban populations is growing.
The HERN on Rural Health will be a single network that will include multiple projects. An overall project plan will be developed by self-identified sites and submitted to the AHA as a coordinated submission. Proposed projects are expected to have a common fundamental theme that will assess intervention(s) and/or approaches that address rural health disparities. All aspects of the network application (each project and the Coordinating Center) will be reviewed as a collective program. The successful network application will be one wherein each project and the Coordinating Center are judged to be exemplary, and thus all components will be funded -- either the entire network (with some possible budgetary adjustments) will be funded, or the entire network will not be funded.
Each network application will include five projects. Each project will be at a distinct institution, and each will be led by a project principal investigator (PI). Each project must have the necessary research team, required infrastructure and ability to recruit and retain a diverse group of study participants, if applicable.
||Thursday, January 26, 2023